难治性产后出血的高危因素分析及治疗研究

目的:分析影响产后出血的的高危因素,针对各种高危因素做好预防及治疗提供理论依据。方法:回顾性分析2009年9月至2012年9月在我院分娩并出现产后出血的产妇150例,设为观察组,选择同期分娩的非产后出血产妇303例做为对照组。采取病例对照的方法分析产后出血的高危因素。并根据观察组的分娩方式分为剖宫产组与阴道产组,剖宫产组根据处理方式又分为宫腔填塞组与B-Lynch术组;阴道产组分为缩宫素组与欣母沛组,比较不同处理方式的治疗效果。结果:我院产后出血的发生率为1.42%,观察组与对照组的产妇年龄、宫缩乏力、软产道损伤、产程异常、胎盘因素、凝血功能障碍、新生儿畸形、妊娠合并症差异有统计学意义(P<0.05),进行多因素Logistic回归分析示宫缩乏力、凝血功能障碍、胎盘因素、妊娠合并症、新生儿畸形是产后出血的高危因素;职业、分娩方式是产后出血的保护因素。观察组中的剖宫产患者以B-Lynch缝合法更优,阴道产组以欣母沛处理更优。结论:产后出血是多因素作用的结果,在产前应明确其高危因素而采取预防措施减少产后出血的发生。

Risk factor and treatment of intractable postpartum hemorrhage

Objective: To analyze risk factor and treatment of intractable postpartum hemorrhage.Methods: A total of 150 cases with postpartum hemorrhage admitted from 2009 September to 2012 September were selected as observation group,and another 303 cases with delivery were selected as the control group.Risk factors of postpartum hemorrhage were analyzed.According to the mode of delivery patients in observation group were divided into cesarean section group,which included two groups: uterine cavity tamponade group and B-Lynch group;and vaginal delivery group,which included oxytocin group and hemabate group.The treatment effect was observed and compared.Results:The incidence of postpartum hemorrhage was 1.42%.There was significant difference in maternal age,uterine atony,injury of soft birth canal,abnormal stage of labor,placental factors,coagulation dysfunction,neonatal abnormalities,pregnancy complications between observation group and control group(P<0.05).Multiple logistic regression analysis revealed that uterine atony,coagulation dysfunction,placental factors,pregnancy complications,neonatal abnormalities were risk factors for postpartum hemorrhage;occupation,mode of delivery were protective factors of postpartum hemorrhage.In cesarean section group,patients with B-Lynch suture had better efficacy,and in vaginal delivery group hemabate showed better efficacy.Conclusions:Postpartum hemorrhage is caused by multiple factors,preventive measures according to risk factors can reduce the incidence of postpartum hemorrhage.