84例产后出血产妇危险因素及临床干预措施分析(1)
[摘要] 目的 探讨导致产妇产后出血的危险因素及临床干预措施。方法 采用回顾性调查对2014年1—12月收治2 125名产妇按照产后出血诊断标准排查出84例发生产后出血产妇。使用logistic回归分析筛选导致产后出血的危险因素，总结干预措施。 结果 导致患者出现产后出血的高危因素依次是宫缩乏力(OR=788.12)、胎盘前置(OR=65.58)、胎盘残留(OR=44.20)、产道损伤(OR=27.55)、流产史(OR=22.18)、产次(ORR=18.34)、剖宫产(OR=15.60)以及凝血功能异常(OR=5.65)。结论 临床工作中要高度重视宫缩乏力，术前制定合理的分娩手术方案及抢救准备，降低产后出血的发生率。
[关键词] 产后出血；危险因素；干预；分娩
[中图分类号] R71 [文献标识码] A [文章编号] 1674-0742(2016)01(a)-0056-02
Analysis of Risk Factors and Clinical Intervention Measures of 84 cases of Puerpera with Postpartum Hemorrhage
WANG Ying， SUN Hong-li， LI Hong
Department of Obstetrics and Gynecology， Luohe Hospital of Traditional Chinese Medicine， Luohe， Henan Province， 462000 China
[Abstract] Objective To discuss the risk factors and clinical intervention measures of 84 cases of puerpera with postpartum hemorrhage. Methods 84 cases of puerpera with postpartum hemorrhage selected from the 2125 puerpera treated in our hospital from January 2014 to December 2014 according to the diagnostic criteria of postpartum hemorrhage were retrospectively surveyed， the risk factors leading to postpartum hemorrhage were screened by logistic regression analysis and the intervention measures were summarized. Results High risk factors causing postpartum hemorrhage in patients was successively uterine atony (OR=788.12)， the placenta praevia (OR=65.58)， residual placenta OR=44.20， birth canal injury OR=27.55， abortion history OR=22.18， parity OR=18.34， cesarean section (OR=15.60) and abnormal coagulation function (OR=5.65). Conclusion We should attach great importance to uterine atony in clinic and make a reasonable delivery operation plan and rescue preparation to reduce the incidence of postpartum hemorrhage.
[Key words] Postpartum hemorrhage； Risk factors； Intervention； Delivery
我国产后出血的发病率约为2%～5%[1]，作为导致产妇死亡的首要原因，及早预防并迅速处置该病是保障孕产妇生命安全的重要手段[2]。为识别和掌握当地导致孕产妇产后出血的危险因素，该研究回顾性分析了2014年1—12月收治的84例产后出血产妇潜在危险因素及临床干预措施，以期指导临床诊疗，现报道如下。
1 资料与方法
1.1 一般资料
整群选择该院住院分娩的2125名产妇，采取回顾性调查方式，排查出84例发生产后出血产妇，发生率为3.95%，其中：平均年龄(26.50±4.85)岁，初产妇71例，经产妇13例，平均分娩孕周(35.65±3.60)周，顺产48例，剖宫产36例。
1.2 方法
1.2.1 产后出血诊断标准 产妇顺产后24 h内出血量≥500 mL或剖宫产后24 h内出血量≥ 1000 mL即诊断为产后出血[3]。
1.2.2 治疗方法 根据实际需要给予患者10 U 缩宫素静脉滴注或肌肉注射，或6～12 U垂体后叶素静脉滴注进行药物缩宫，同时行子宫按摩促进宫缩，彻底清除宫腔残留，出血量大时，对宫腔进行填纱压迫止血或择机进行子宫动脉栓塞，及时给与输液、输血强化治疗[4]。
1.3 观察指标
患者年龄、孕周、产次、流产史、胎儿体重、大小、单胎或多胎、分娩方式、出血量、出血原因以及相关治疗措施。
1.4 统计方法
使用SPSS 19.0软件分析数据，产后出血原因以百分比(%)表示，使用多因素logistic逐步回归分析，剔除变量水平为0.05。 (王瑛 孙红丽 李红)
[关键词] 产后出血；危险因素；干预；分娩
[中图分类号] R71 [文献标识码] A [文章编号] 1674-0742(2016)01(a)-0056-02
Analysis of Risk Factors and Clinical Intervention Measures of 84 cases of Puerpera with Postpartum Hemorrhage
WANG Ying， SUN Hong-li， LI Hong
Department of Obstetrics and Gynecology， Luohe Hospital of Traditional Chinese Medicine， Luohe， Henan Province， 462000 China
[Abstract] Objective To discuss the risk factors and clinical intervention measures of 84 cases of puerpera with postpartum hemorrhage. Methods 84 cases of puerpera with postpartum hemorrhage selected from the 2125 puerpera treated in our hospital from January 2014 to December 2014 according to the diagnostic criteria of postpartum hemorrhage were retrospectively surveyed， the risk factors leading to postpartum hemorrhage were screened by logistic regression analysis and the intervention measures were summarized. Results High risk factors causing postpartum hemorrhage in patients was successively uterine atony (OR=788.12)， the placenta praevia (OR=65.58)， residual placenta OR=44.20， birth canal injury OR=27.55， abortion history OR=22.18， parity OR=18.34， cesarean section (OR=15.60) and abnormal coagulation function (OR=5.65). Conclusion We should attach great importance to uterine atony in clinic and make a reasonable delivery operation plan and rescue preparation to reduce the incidence of postpartum hemorrhage.
[Key words] Postpartum hemorrhage； Risk factors； Intervention； Delivery
我国产后出血的发病率约为2%～5%[1]，作为导致产妇死亡的首要原因，及早预防并迅速处置该病是保障孕产妇生命安全的重要手段[2]。为识别和掌握当地导致孕产妇产后出血的危险因素，该研究回顾性分析了2014年1—12月收治的84例产后出血产妇潜在危险因素及临床干预措施，以期指导临床诊疗，现报道如下。
1 资料与方法
1.1 一般资料
整群选择该院住院分娩的2125名产妇，采取回顾性调查方式，排查出84例发生产后出血产妇，发生率为3.95%，其中：平均年龄(26.50±4.85)岁，初产妇71例，经产妇13例，平均分娩孕周(35.65±3.60)周，顺产48例，剖宫产36例。
1.2 方法
1.2.1 产后出血诊断标准 产妇顺产后24 h内出血量≥500 mL或剖宫产后24 h内出血量≥ 1000 mL即诊断为产后出血[3]。
1.2.2 治疗方法 根据实际需要给予患者10 U 缩宫素静脉滴注或肌肉注射，或6～12 U垂体后叶素静脉滴注进行药物缩宫，同时行子宫按摩促进宫缩，彻底清除宫腔残留，出血量大时，对宫腔进行填纱压迫止血或择机进行子宫动脉栓塞，及时给与输液、输血强化治疗[4]。
1.3 观察指标
患者年龄、孕周、产次、流产史、胎儿体重、大小、单胎或多胎、分娩方式、出血量、出血原因以及相关治疗措施。
1.4 统计方法
使用SPSS 19.0软件分析数据，产后出血原因以百分比(%)表示，使用多因素logistic逐步回归分析，剔除变量水平为0.05。 (王瑛 孙红丽 李红)