高龄经产妇剖宫产术中出血风险因素分析

Analysis of Risk Factors of Hemorrhage During Cesarean Section in Multiparous Women with Advanced Delivery Age

【目的】分析高龄经产妇剖宫产术中出血风险因素,为防治剖宫产术中出血提供理论依据。【方法】回顾分析2015年1月至2019年12月在中山大学附属第一医院高龄经产妇剖宫产1838例临床资料。根据产妇术中出血量是否≥500 mL,分为出血组与常规出血组,分析产妇基本资料、术中因素、胎盘因素等各类因素与术中出血相关性,通过多因素二分类Logistic回归分析得出独立风险因素。【结果】Logistic回归分析显示,手术时间[OR=1.069,95%CI为(1.050,1.089),P<0.001]、胎盘娩出方式[OR=3.131,95%CI为(1.259,7.782),P=0.014]、胎儿窘迫[OR=4.727,95%CI为(1.191,18.763),P=0.027]、手术级别[OR=21.494,95%CI为(6.031,76.611),P<0.001]、麻醉方式[OR=2.904,95%CI为(1.158,7.281),P=0.023]和宫缩乏力[OR=7.255,95%CI为(4.413,11.927),P<0.001]为术中出血独立风险因素。【结论】手术时间、胎儿窘迫、手术级别、麻醉方式、宫缩乏力、胎盘娩出方式是高龄经产妇剖宫产术中出血主要影响因素,临床应针对以上风险因素,制定相应措施,以减低剖宫产术中出血风险。

【Objective】To analyze the risk factors of hemorrhage during cesarean section in multiparous women with advanced delivery age,and provide a theoretical basis for the prevention and treatment of hemorrhage during cesarean section.【Methods】We retrospectively analyzed the clinical data of 1838 women with advanced maternal age undergoing cesarean section in the First Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2019.According to whether the intraoperative blood loss of the parturient is≥500 mL,they were divided into hemorrhage group and non-hemorrhage group.The correlations of various factors such as basic maternal data,intraoperative factors,placental factors and intraoperative hemorrhage,and obtain the results by multi-factor binary logistic regression analysis independent risk factors were analyzed.【Results】Logistic regression analysis showed that operation time[OR=1.069,95%CI:(1.050,1.089),P<0.001],placenta delivery method[OR=3.131,95%CI:(1.259,7.782),P=0.014],fetal distress[OR=4.727,95%CI:(1.191,18.763),P=0.027],surgical grade[OR=21.494,95%CI:(6.031,76.611),P<0.001],anesthesia method[OR=2.904,95%CI:(1.158,7.281),P=0.023]and weak uterine contractions[OR=7.255,95%CI:(4.413,11.927),P<0.001]were independent risk factors for intraoperative hemorrhage.【Conclusions】Operation time,fetal distress,operation level,anesthesia,uterine weakness,and placental delivery are the main influencing factors for bleeding during cesarean section in elderly women who have undergone cesarean section.Clinical measures should be taken to reduce the risk of hemorrhage during cesarean section.