不同年代产后出血346例临床特点分析

目的 通过对我院产后出血的病例进行回顾性分析，比较不同年代产后出血病例特点的变化。方法 对1993～1995年、2002-2004年共346例产后出血病例分为前后3年两组进行回顾性对比分析，包括年龄、孕周、产次、分娩方式、产后出血原因、分娩前后血红蛋白（HB）和血球压积（HCV）变化等指标。结果 2002年-2004年产后出血发生率较1993年～1995年明显上升。后3年产妇年龄较前3年增加。剖宫产分别占两组产后出血病例的49．04％和51．24％。宫缩乏力仍然是导致产后出血的第一位原因（51．9％vs58．7％），胎盘因素有显著上升（14．1％VS20．7％）。产后出血产妇分娩前后血红蛋白下降值和血球压积下降值后3年明显低于前3年（P〈0．05）。6年间因产后出血行子宫切除7例，其中5例为胎盘因素。结论 宫缩乏力仍是产后出血的首要原因，胎盘因素导致的产后出血近年来有所增加，成为产后出血的第二位原因，并成为导致子宫切除的严重产后出血的主要原因。

Analysis of 346 cases of postpartum hemorrhage in various ages

Objective To analyze the changes of postpartum hemorrhage (PPH) in various ages. Methods We retrospectively reviewed all the cases of PPH treated in our hospital during two periods of time: from 1993 to 1995 for the early group, from 2002 to 2004 for the late group. All the factors possibly related to PPH were statistically analyzed between the two groups, such as age, gestational weeks, causes of bleeding, blood loss, et al. Results The incidence of PPH in our hospital was significantly increased from 2.65% for the early group to 8.82% for the late group. Uterine atony remained the top cause of PPH. Placental factor was increased to 20.7% for the late group from 14.1% for the early one. The early group wais with more severe decline of HB and HCV. Seven women underwent hysterectomy for PPH in our study. Among them 5 were due to placental factor.Conclusions Uterine atony remains the first cause of PPH. Placental factor is the second cause of PPH and the primary cause of severe PPH that requires hysterectomy.