阴道分娩产妇会阴血肿现状及危险因素的病例对照分析

A case-control analysis of perineal hematoma and its risk factors in pregnant women undergoing vaginal delivery

目的通过回顾性病例对照研究, 探讨阴道分娩产妇会阴血肿的发生现状及相关影响因素, 为预防其发生及制订科学有效的护理干预提供支持。方法将2018年10月至2020年3月在同济大学附属第一妇婴保健院阴道分娩发生会阴血肿的102例产妇作为血肿组, 按照1∶2配比比例收集未发生会阴血肿204例产妇作为无血肿组。通过文献回顾和专家咨询确定24个可能的影响因素, 通过临床病例回顾性调查收集资料, 采用单因素分析、t检验、χ^(2)检验, 多因素二分类Logistic回归分析, 探究阴道分娩产妇发生会阴血肿的危险因素。结果 2018年10月至2020年3月阴道分娩的18 292例, 发生会阴血肿102例, 会阴血肿发生率为0.56%, 单因素分析共筛选出10个与阴道分娩会阴血肿发生有统计学意义的因素(t/χ^(2)值为-4.51~31.79, 均P<0.05), 经多因素二分类Logistic回归分析发现, 高龄产妇(OR=7.53, P<0.05)、会阴水肿(OR=3.10, P<0.05)是阴道分娩会阴血肿的危险因素, 自由体位分娩(OR=0.35, P<0.05)、陪伴分娩(OR= 0.31, P<0.05)是保护性因素。结论阴道分娩产妇会阴血肿的发生率较高、好发于会阴右侧及产后2 h。临床上应积极推广助产优质护理服务, 降低会阴血肿发生率。

Objective To provide data support for preventing its occurrence and developing scientific and effective nursing intervention by investigating the situation and risk factors of perineal hematoma in pregnant women undergoing vaginal delivery through retrospective case-control study.Methods A total of 102 parturients who had perineal hematoma during vaginal delivery in Shanghai Maternity and Infant Hospital Affiliated to Tongji University were selected as the hematoma group,from October 2018 to March 2020,and case control study(n=204)was performed in the ratio of 1∶2.24 possible influencing factors were determined by literature review and expert consultation and the data were collected retrospectively by clinicopathology.Single factor analysis,t test,Chi-square test and Multivariate binary Logistic regression analysis were used to identify factors related to perineal hematoma,and to explore potential risk factors of perineal hematoma.Results From October 2018 to March 2020,there were 18292 cases of vaginal delivery,including 102 cases of perineal hematoma,with an incidence of 0.56%.Single factor analysis showed 10 risk factors pertinent to perineal hematoma were selected(t/χ^(2) values were-4.51 to 31.79,all P<0.05);and multiple Logistic regression analysis showed the risk factors of perineal hematoma in vaginal delivery were old puerperal(OR=7.53,P<0.05)and perineal edema(OR=3.10,P<0.05),and the protective factors were free position delivery(OR=0.35,P<0.05)and concomitant delivery(OR=0.31,P<0.05).Conclusions The incidence of perineal hematoma is relatively high in pregnant women undergoing vaginal delivery,usually occurrs on the right side of the perineal vagina and within 2 hours after delivery.Clinically,it is necessary to actively promote quality nursing services at midwifery to reduce the incidence of perineal hematoma.