阴道分娩产后出血量的精确测定与血液指标的关系研究

The Accurate Mensuration of Bleeding and the Relationship of Blood Parameters in Vaginal Deliveries

目的 :探讨产后出血量的测定与血液指标变化的关系。方法 :采用前瞻性研究方法。选择经阴道分娩的足月产妇共 6 30例 ,产后出血量的收集计量采用称重法 ,由专人精确测量从会阴切开至产后 2 4小时各阶段的出血量 ,再按血液比重换算成容积。血液容积 (ml) =血液重量 (g)÷ 1.0 5。在接产前及分娩后 4小时分别抽取肘静脉血 0 .5ml,即刻测定血红蛋白、红细胞计数、血小板数、血细胞比容。结果 :产后 2 4小时总出血量平均为 5 5 4.2± 2 73.1ml,其中产后 2小时内出血量为 42 0 .2± 2 5 9.1ml,占产后 2 4小时总出血量的 75 .8%,第三产程出血量为 2 12 .0± 180 .9ml,占产后 2小时内出血量的 5 0 .5 %。在 6 30例阴道分娩中 ,产后 2 4小时总出血量 >5 0 0ml者 ,共 319例 ,占 5 0 .6 %。产后 2 4小时总出血量 >10 0 0ml者 ,共 39例 ,占 6 .2 %。产后 4小时血红蛋白、红细胞计数、血细胞比容较产前下降 ,差异有显著性 (P <0 .0 1) ,尤以产后 2 4小时总出血量 >10 0 0ml者变化显著 ,而血小板的变化差异无显著性 (P >0 .0 5 )。结论 :以产后 2 4小时总出血量超过 5 0 0ml作为产后出血的诊断标准 ,则 6 30例产妇中有产后出血者 319例 ,产后出血的发生率为 5 0 .6 %。故是否需重新定义产后出血的量是值得研究的问题?

Objective: To investigate the accurate mensuration of bleeding after delivery and the relationship of bleeding with the blood parameters. Methods: In this prospective study, 630 normal termed pregnant women were observed from 1998 to 2000. The amount of bleeding was measured by weighty method. We collected the bleeding from episiotomy to 24 hrs after deliver.The peripheral blood were collected and measured hemoglobin, red blood cell, blood platelet, and hematocrit before delivery and 4 hrs after delivery. Results: The mean bleeding of 24 hrs after delivey was 554.2±273.1 ml. The bleeding in 2 hrs after delivery was 420.2±259.1 ml and accounted for 75.8% of 24 hrs bleeding. The bleeding in the third stage was 212.0±180.9 ml and accounted for 50.5% of 24 hrs bleeding. In 630 women, there were 319 women with blood loss over exceeding 500 ml with in 24 hrs after delivery (50.6%). At 4 hrs after delivery, the blood parameters were significantly lower than those before delivery(P<0.01).Except blood platelet which had no difference(P>0.05). Conclusions: The prevelance of postpartum hemorrhage was 50.6%, according to the criteria of postpartum hemorrhage is over 500 ml with in 24 hrs after delivery. We suggested to revise this criterion. We also found that the blood parameters at 4 hrs after delivery were lower than prenatal.