凶险性前置胎盘患者产后并发大出血的原因分析及护理对策

Analysis of the causes of postpartum hemorrhage in pernicious placenta previa patients and its nursing countermeasures

目的探讨凶险性前置胎盘患者产后并发大出血的危险因素及护理对策。方法选择我院2017年3月至2019年3月收治的凶险性前置胎盘(PPP)患者200例为研究对象,产后出现大出血62例,采用单因素和多因素logistic回归分析导致PPP患者发生产后大出血的影响因素,并探讨护理对策。结果单因素分析结果表明,患者年龄、平均分娩孕周、近5年妊娠次数、近5年分娩次数、新生儿体质量、胎盘着位情况与出现产后大出血无关(P>0.05),护理方案、胎盘黏连、胎盘植入、剖宫产次数、产程中手术、前置胎盘分类是导致产后大出血的因素(P<0.05);多因素logistic回归分析结果表明,胎盘黏连、前置胎盘类型、产程中手术是导致PPP产后并发大出血的独立危险因素(P<0.05)。结论对PPP患者进行详细的产前检查,确定孕妇胎盘状况、前置胎盘类型,同时手术过程实施护理行为感知模式护理干预能够有效降低PPP患者产后大出血发生率。

Objective To investigate the risk factors of postpartum hemorrhage in pernicious placenta previa(PPP)patients and its nursing countermeasures.Methods To select 200 cases of PPP patients admitted in our hospital from March 2017 to March 2019 as the study objects,and there were 62 cases of postpartum hemorrhage to occur.The influencing factors of postpartum hemorrhage in PPP patients were analyzed by univariate and multivariate logistic regression to explore nursing countermeasures.Results Univariate analysis showed that the patient's age,the average gestational week,the number of gestations in the past 5 years,the number of deliveries in the last 5 years,the weight of the newborn,and the condition of placental position were not related to the occurrence of postpartum hemorrhage(P>0.05).Nursing plans,placental adhesion,placental implantation,number of cesarean sections,surgery during stage of labor,and placenta previa classification were factors that cause concurrent postpartum hemorrhage after delivery(P<0.05).Multivariate logistic regression analysis showed that the placental adhesion,type of placenta previa and surgery during stage of labor were independent risk factors that cause concurrent postpartum hemorrhage after PPP delivery(P<0.05).Conclusion Medical staff should implement a detailed prenatal examination for PPP patients to determine the placental status and type of placenta previa in pregnant women,at the same time,the intervention of perceptual mode nursing in the surgical process could effectively reduce the incidence rate of postpartum hemorrhage in PPP patients.