严重产后出血及与其相关的子宫切除危险因素分析

Analysis and discussion on risk factors of severe postpartum hemorrhage and its related perinatal hysterectomy

目的探讨严重产后出血(severe postpartum hemorrhage,SPPH)的独立危险因素及导致子宫切除不良事件发生的危险因素。方法回顾分析2015年7月至2017年12月于广州医科大学附属第一医院分娩的157例产后出血患者的临床资料,并根据失血程度将其分为SPPH组(39例)和非SPPH组(118例),比较两组患者产前及产时出血原因和相关因素,同时分析SPPH组患者子宫切除的相关因素。结果SPPH组患者产前纤维蛋白原水平(4.18±1.01)g/L,非SPPH组(4.61±0.79)g/L,两组间存在显著性差异(t=-2.689,P<0.05),两组合并子宫肌瘤发生率分别为10.3%和0.8%,差异有统计学意义(χ^(2)=5.641,P<0.05)。多因素分析结果显示,SPPH与产前纤维蛋白原水平以及是否子宫肌瘤合并妊娠有关(P<0.05)。SPPH患者中,子宫切除组胎盘植入发生率为50%,非子宫切除组为3.4%,两组间差异有统计学意义(P=0.002)。结论产前纤维蛋白原水平偏低、子宫肌瘤合并妊娠是导致SPPH的独立危险因素。胎盘植入、凝血功能障碍、产后出血量是导致围产期子宫切除的危险因素。

Objective To explore the independent risk factors of severe postpartum hemorrhage(SPPH)and the risk factors leading to adverse events of hysterectomy.Methods We retrospectively analyzed the clinical data of 157 postpartum hemorrhage(PPH)patients who delivered in the First Affiliated Hospital of Guangzhou Medical University from July 2015 to December 2017.According to the degree of blood loss,it was divided into severe postpartum hemorrhage(39 cases in group A)and non-severe postpartum hemorrhage(118 cases in group B).The prenatal and perinatal factors,causes of bleeding and the related factors of hysterectomy were analyzed.Results The prenatal fibrinogen level in the severe postpartum hemorrhage group(group A)was(4.18±1.01)g/L,and the prenatal fibrinogen level in the postpartum hemorrhage group(group B)was(4.61±0.79)g/L.There was a significant difference(t=-2.689,P<0.05).The incidence of combined uterine fibroids in the two groups was 10.3%and 0.8%,respectively,which was a significant difference comparing in the groups(χ^(2)=5.641,P<0.05).The results of multivariate analysis showed that severe postpartum hemorrhage was related to prenatal fibrinogen level and whether uterine fibroids complicated with pregnancy(P<0.05).Compared with two groups,the incidence of placental implantation was higher in the hysterectomy subgroup(50%)than in the non-hysterectomy subgroup(3.4%),which was significant differences(P=0.002).Conclusions Low prenatal fibrinogen levels and hysteromyoma associated with pregnancy are independent risk factors for severe postpartum hemorrhage.Placenta accreta,coagulopathy and amount of postpartum bleeding are risk factors for perinatal hysterectomy.