中心静脉血氧饱和度、血乳酸及凝血四项预测严重产后出血预后的价值

Predictive value of central venous oxygen saturation,blood lactate and four coagulation indexes for the prognosis of severe postpartum hemorrhage

目的探讨中心静脉血氧饱和度(ScvO2)、血乳酸(LAC)及凝血四项[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)]对严重产后出血患者预后的预测价值。方法选择2020年5月至2021年6月海南医学院第二附属医院收治的110例严重产后出血患者为研究对象(重度组),并分别以71例同期轻度产后出血患者及58例未出现产后出血者为轻度组及对照组,分析ScvO2、LAC及凝血指标与产后出血严重程度的相关性;根据产妇生存情况及产后并发症发生情况将重度组分为预后较好组及预后不良组,分析ScvO2、LAC及凝血指标对严重产后出血患者预后的预测价值。结果ScvO2、FIB值随着产后出血的加重而减小,LAC、PT、APTT、TT值随着产后出血的加重而增大,差异有统计学意义(F值介于55.127~529.745之间,P<0.05);ScvO2、FIB值与产后出血严重程度呈负相关,LAC、PT、APTT、TT值与产后出血严重程度呈正相关(r值分别为-0.432、-0.301、0.366、0.252、0.228、0.436,P<0.05);预后不良组的ScvO2、FIB值小于预后较好组,LAC、PT、APTT、TT值大于预后较好组,差异均有统计学意义(t值介于2.191~4.920之间,P<0.05);ScvO2、LAC及凝血指标联合预测严重产后出血患者预后的曲线下面积为0.978,大于各指标单独检测(P<0.05)。结论产后出血患者ScvO2、LAC及PT、APTT、TT、FIB值与病情严重程度相关,且联合检测对患者预后具有较高的预测价值。

Objective To explore the predictive value of central venous oxygen saturation(ScvO2),blood lactate(LAC)and four coagulation indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)]for the prognosis of severe postpartum hemorrhage.Methods A total of 110 patients with severe postpartum hemorrhage who were admitted to the Second Affiliated Hospital of Hainan Medical University from May 2020 to June 2021 were selected as the severe group,while 71 patients with mild postpartum hemorrhage and 58 patients without postpartum hemorrhage during the same period were enrolled as the mild group and the control group,respectively.The correlation between ScvO2,LAC and coagulation indexes and the severity of postpartum hemorrhage was analyzed.According to maternal survival and occurrence of postpartum complications,patients in severe group were divided into the good prognosis group and the poor prognosis group.Predictive value of ScvO2,LAC and coagulation indexes for the prognosis in patients with severe postpartum hemorrhage was analyzed.Results The values of ScvO2 and FIB decreased with the aggravation of postpartum hemorrhage,while the values of LAC,PT,APTT and TT increased with the aggravation of postpartum hemorrhage,with statistical significance(F values ranged from 55.127 to 529.745,P<0.05).ScvO2 and FIB were negatively correlated with the severity of postpartum hemorrhage,while LAC,PT,APTT and TT were positively correlated with the severity of postpartum hemorrhage(r values were-0.432,-0.301,0.366,0.252,0.228,0.436,respectively,P<0.05).The ScvO2 and FIB values in the poor prognosis group were lower than those in the good prognosis group,while the values of LAC,PT,APTT and TT were higher than those in the good prognosis group,the differences were statistically significant(t value ranged from 2.191 to 4.920,P<0.05).The area under the curve(AUC)of ScvO2,LAC and coagulation indicators combined to predict the prognosis of patients with severe postpartum hemorrhage was 0.978,which was higher than that of each indicator alone(P<0.05).Conclusion The values of ScvO2,LAC,PT,APTT,TT and FIB are related to the severity of the disease in patients with postpartum hemorrhage,and the combined detection has a higher predictive value for the prognosis of patients.