产后出血伴发凝血功能障碍的相关危险因素分析

Analysis of risk factors related to postpartum hemorrhage combined with coagulation dysfunction

目的分析产后出血伴发凝血功能障碍的一般情况及相关危险因素,提高临床医生对产后出血高危因素的认识和救治。方法回顾性分析我院2016年1月~2018年12月产科MICU收治的产后出血伴发凝血功能障碍的产妇58例作为观察组,按照出血量多少(<30%,30%~50%,51%~70%,>70%)分成四组,比较各组在活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、血红蛋白(HB)、血小板(Plt)水平差异;同时选择同期产后出血没有伴发凝血功能障碍的产妇59例作为对照组,对产后出血相关危险因素行Logistic回归分析。结果在观察组中四组凝血指标比较无明显统计学差异;在产后出血高危因素中,瘢痕子宫、前置胎盘、胎盘植入在观察组与对照组两组之间比较差异有统计学意义(P<0.05),Logistic回归分析显示瘢痕子宫、胎盘植入与产后出血伴发凝血功能障碍明显相关(OR=4.249,95%CI=1.506~11.984,P=0.006;OR=5.880,95%CI=1.551~22.296,P=0.009)。结论瘢痕子宫、胎盘植入与产后出血早期凝血功能障碍明显相关,是产后出血早期出现凝血功能障碍的高危因素。

Objective To analyze the general situation and related risk factors of postpartum hemorrhage accompanied by coagulation dysfunction,and to improve clinicians'understanding of high risk factors and treatment for postpartum hemorrhage.Methods Fifty-eight cases of postpartum hemorrhage combined with coagulation dysfunction from January 2016 to December 2018 were selected as the observation group,and were divided into four groups according to the amount of bleeding(<30%,30%-50%,51%-70%,>70%).The levels of activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(Fib),hemoglobin(HB),and platelet(Plt)between groups were compared.At the same time,59 women with postpartum hemorrhage who had no coagulation dysfunction during the same period were selected as the control group.Logistic regression analysis was performed on risk factors related to postpartum hemorrhage.Results In the observation group,there was no significant statistical difference between the four groups of coagulation indicators.Among the high risk factors for postpartum hemorrhage,there were statistically significant differences in scar uterus,placenta previa,and placenta accreta between the observation group and the control group(P<0.05).Logistic regression analysis showed that scar uterus and placenta accreta were significantly associated with postpartum hemorrhage accompanied by coagulation dysfunction(OR=4.249,95%CI=1.506-11.984,P=0.006;OR=5.880,95%CI=1.551-22.296,P=0.009).Conclusion Scar uterus and placenta accreta are significantly related to coagulation dysfunction in early postpartum hemorrhage,and are high-risk factors for coagulation dysfunction in early postpartum hemorrhage.