高危初产妇剖宫产后发生PPH的危险因素分析

PPH Risk Factors Analysis of High-Risk Primipara after Cesarean Section

目的探究高危初产妇剖宫产后引发产后出血(postpartum hemorrhage,PPH)的危险因素。方法选取2021年8月—2023年8月富川县人民医院妇产科收治的高危初产妇78例作为研究对象,依据是否发生PPH分为发生组(19例)与未发生组(59例)。对两组患者一般资料给予单因素分析,将单因素分析具有统计学差异的项目通过自变量赋值后纳入多因素logistic回归分析,并构建回归方程以验证模型拟合度,在模型拟合度较好的情况下,提出预防性措施。结果单因素分析发现两组体质量指数、学历、妊娠期糖尿病、孕周、人血白蛋白水平的比较差异无统计学意义(P>0.05);年龄、妊娠期高血压疾病、前置胎盘、宫缩乏力、血小板水平与PPH发生有关(P<0.05)。将以上差异项纳入多因素Logistic回归分析发现,年龄≥35岁、存在妊娠期高血压疾病、存在前置胎盘、存在宫缩乏力、血小板水平≤100×10^(9)/L是高危初产妇剖宫产后发生PPH的危险因素(P<0.05)。构建高危初产妇剖宫产后发生PPH的危险因素方程,得到Logit(P)=-5.204+1.623×(年龄≥35岁)+0.824×(存在妊娠期高血压疾病)+1.715×(存在前置胎盘)+0.769×(存在宫缩乏力)+0.803×(血小板水平≤100×10^(9)/L)。利用模型系数Omnibus检验评价模型总体,χ^(2)=76.298,自由度=5,P<0.001,提示模型总体有意义;利用Hosmer-Lemesho检验对拟合优度效果予以质性评价,χ^(2)=7.601,DF=8,P=0.533,说明该模型拟合优度较好。结论存在年龄≥35岁、妊娠期高血压疾病、前置胎盘、宫缩乏力、血小板水平≤100×10^(9)/L因素的高危初产妇剖宫产后发生PPH的风险较高,护理人员应对其多加注意,并及时采取有效措施以降低PPH发生率。

Objective To explore risk factors for postpartum hemorrhage(PPH)of high-risk primipara after cesarean section.Methods The paper chose 78 high-risk primipara in obstetrics and gynecology department of Fuchuan County People's Hospital from August 2021 to August 2023 as research subjects,and divided them into occurrence group(19 cases)and non occurrence group(59 cases)based on condition of PPH.Univariate analysis of general data was carried out between two groups.Items with statistical difference in univariate analysis were assigned with independent variables and included for multivariate logistic regression analysis.Regression equations were constructed to verify model fit degree,and propose preventive measures based on good fit model.Results Univariate analysis showed,there was no significant difference between two groups in body mass index,education,gestational diabetes,gestational weeks,and serum albumin levels(P>0.05).Age,gestational hypertension,placenta previa,uterine atony,platelet levels were associated with incidence of PPH(P<0.05).Multivariate logistic regression analysis based on items with difference found,age≥35,gestational hypertension,placenta previa,uterine atony,and platelet levels≤100×10^(9)/L were PPH risk factors of high-risk primipara after cesarean section(P<0.05).Constructing PPH risk factor equation of high-risk primipara after cesarean section showed,Logit(P)=-5.204+1.623 x(age≥35)+0.824 x(gestational hypertension)+1.715 x(placenta previa)+0.769 x(uterine atony)+0.803 x(platelet level≤100×10^(9)/L).Overall model evaluation with model coefficient Omnibus test showed,χ^(2)=76.298,degree of freedom=5,P<0.001,indicating overall significance of the model.Qualitative evaluation of fit degree with the Hosmer Lemesho test showed,χ^(2)=7.601,DF=8,P=0.533,indicating good fit of the model.Conclusion High risk primipara with age≥35,gestational hypertension,placenta previa,uterine atony,and platelet levels≤100×10^(9)/L have higher risk of PPH after cesarean section.Nursing staff should pay attention to the factors and take timely and effective measures to reduce incidence of PPH.