24 h精准计量产后出血及预警管理临床研究

24-hour accurate measurement of postpartum hemorrhage and its early warning value

背景产后出血是阴道分娩最常见的并发症,也是孕产妇死亡的首要原因。大多数产后出血导致的死亡是可以避免的,关键在于早诊断、早预警。然而目前临床上估计的失血量相比实际失血量要低,易导致错过抢救时机。目的探讨一种针对产后出血的24 h精准计量及预警管理模式。方法选取2022年1月-2023年5于北京市海淀区妇幼保健院经阴道分娩的5546例产妇作为实验组,2020年8月-2021年12月于该院分娩的5967例产妇作为对照组。实验组采用精准计量产后出血及预警管理模式,即通过对孕产妇进行产前风险筛查评估,及时识别高危因素;产时应用产程计量垫及产后集血垫进行产后24 h出血量的精准计量,并根据预警线及时预警并处理。对照组采用常规方法。分析两组出血量计量的准确度、产后出血和严重产后出血发生率,以及中重度贫血患病率。结果实验组产后24 h出血量与血红蛋白校正出血量、红细胞比容校正出血量相符,差异无统计学意义(P>0.05),而对照组出血量显著少于血红蛋白校正出血量及红细胞比容校正出血量(P<0.01)。实验组产后2 h出血量[(257.65±69.89)mL vs(280.34±68.32)mL]、24 h出血量[(419.42±91.28)mL vs(488.06±108.36)mL]均低于对照组,差异有统计学意义(P<0.05)。实验组产后出血发生率较对照组低(5.27%vs 9.73%,P<0.001),严重产后出血发生率较对照组低(0.18%vs 0.45%,P<0.01),中重度贫血患病率较对照组低(3.30%vs 6.78%,P<0.001)。结论24 h精准计量产后出血及预警管理模式显著提高了估测失血量的准确度,可有效降低产后出血、严重产后出血发生率及中重度贫血患病率,这种模式值得在临床中推广使用。

Background Postpartum hemorrhage(PPH)is the most common complication of vaginal delivery and the leading cause of maternal mortality.The majority of deaths resulting from PPH are preventable,early detection and timely intervention are important.However,currently,the estimated blood loss in clinics tends to be underestimated,leading to missed opportunities for rescue.Objective To explore a 24 h accurate measurement and early warning management model for PPH.Methods The experimental group included 5546 women who underwent vaginal delivery at Beijing Haidian Maternal and Child Health Hospital from January 2022 to May 2023.The control group comprised 5967 women who delivered at the same hospital from August 2020 to December 2021.The experimental group implemented an accurate measurement and early warning management model for PPH,which involved prenatal risk assessment to identify high-risk factors,the use of labor measurement pad and postpartum blood collection pads for precise measurement of blood loss within 24 h after childbirth,and timely intervention based on predetermined warning thresholds.The main outcome measures included the accuracy of blood loss measurement,the incidence of PPH and severe PPH,and the prevalence of moderate to severe anemia.Results The postpartum blood loss within 24 h in the experimental group was consistent with hemoglobin-adjusted blood loss and hematocrit-adjusted blood loss,showing no statistically significant differences(P>0.05).In contrast,the control group exhibited significantly lower blood loss compared to hemoglobin and hematocritadjusted blood loss(P<0.01).Our study revealed that the experimental group had lower postpartum blood loss at 2 h and 24 h,with values of(257.65±69.89)mL and(419.42±91.28)mL,respectively,which were significantly lower than those of the control group([280.34±68.32]mL and[488.06±108.36]mL,respectively)with statistically significant difference(P<0.05).The incidence of PPH in the experimental group was lower than that in the control group(5.27%vs 9.73%,P<0.001),as well as the incidence of severe PPH(0.18%vs 0.45%,P<0.01),and the prevalence of moderate to severe anemia(3.30%vs 6.78%,P<0.001).Conclusion The 24 h accurate measurement and early warning management model for PPH significantly improves the accuracy of blood loss estimation and effectively reduces the incidence of PPH,severe PPH,and moderate to severe anemia,which is worth promoting and implementing in clinical practice.