难治性产后出血导致子宫切除的危险因素分析

Analysis of risk factors of hysterectomy caused by intractable postpartum hemorrhage

目的·探讨难治性产后出血导致产科急症子宫切除的危险因素以及相关预防措施。方法·回顾性分析2014年1月—2020年12月于上海交通大学医学院附属国际和平妇幼保健院收治的110934例产妇的临床资料。根据收治时间,选择其中2015—2017年段(n=48984)和2018—2020年段(n=45262)的产妇为研究对象,分析其产科急症子宫切除发生率的情况;选择其中发生难治性产后出血的108例产妇为研究对象,根据是否行子宫切除,将其分为子宫切除组(n=22)与子宫保留组(n=86),采用单因素分析及多因素Logistic回归模型对该2组患者的临床资料进行比较分析,并探究产科急症子宫切除的危险因素。结果·与2015—2017年段相比,2018—2020年段的产科急症子宫切除发生率下降(P=0.039);与子宫保留组相比,子宫切除组患者的年龄偏大,孕次≥2次、单胎妊娠、发生妊娠合并症(前置胎盘、胎盘植入、瘢痕子宫等)、羊水栓塞者的占比均较高,产后出血量更大(均P<0.05)。多因素Logistic回归分析显示,患者的年龄、产后出血量均是难治性产后出血导致产科急症子宫切除的独立危险因素(P<0.05)。结论·难治性产后出血产妇的年龄越高、出血量越大,越容易导致产科急症子宫切除的发生。临床上需尽早开展监测并进行干预,以降低该类患者产科急症子宫切除的发生率。

Objective·To investigate the risk factors and related preventive measures of intractable postpartum hemorrhage which leads to emergency peripartum hysterectomy.Methods·The clinical data of 110934 pregnant women treated in the International Peace Maternal&Child Health Hospital,Shanghai Jiao Tong University School of Medicine from January 2014 to December 2020were analyzed retrospectively.According to the treated time,pregnant women in the 2015-2017 year-period(n=48984)and 2018-2020 year-period(n=45262)were selected as the research objects to analyze the incidence of emergency peripartum hysterectomy.Besides,a total of 108 pregnant women with intractable postpartum hemorrhage were selected as the research objects.The patients were divided into the uterine-removed group(n=22)and the uterine-preserved group(n=86)according to whether they had hysterectomy.The clinical data of the two groups were compared and analyzed by univariate analysis and multivariate Logistic regression model,and the risk factors of emergency peripartum hysterectomy were explored.Results·Compared with the 2015-2017 year-period,the incidence of emergency peripartum hysterectomy decreased in the 2018-2020 year-period(P=0.039).Meanwhile,compared with the uterine-preserved group,the pregnant women in the uterine-removed group were older,with more than 2 pregnancies,monocyesis,pregnancy complications(placenta previa,placenta implantation,scarred uterus,etc.),amniotic fluid embolism and greater postpartum hemorrhage(all P<0.05).Multivariate Logistic regression analysis showed that the patients’age and the volume of postpartum hemorrhage were independent risk factors for emergency peripartum hysterectomy caused by intractable postpartum hemorrhage(P<0.05).Conclusion·The older the patients with intractable postpartum hemorrhage,the greater volume of postpartum hemorrhage,which is easy to lead to emergency peripartum hysterectomy.Clinical monitoring and intervention should be carried out as soon as possible to reduce the patients’incidence of emergency peripartum hysterectomy.