难治性产后出血中紧急子宫切除的高危因素及不良结局

目的分析难治性产后出血中紧急子宫切除的原因、高危因素及不良结局。方法回顾性分析产科住院分娩的发生难治性产后出血的250例患者的临床资料，其中行紧急子宫切除的患者78例，通过单因素及二元logistic回归分析筛选出难治性产后出血中紧急子宫切除的高危因素，并分析原因及不良结局。结果导致紧急子宫切除常见的原因依次为胎盘因素、胎盘因素+凝血功能障碍、凝血功能异常、宫缩乏力及胎盘因素+子宫破裂；既往剖宫产史及胎盘植入是难治性产后出血中紧急子宫切除的高危因素(P＜0.05) ；行紧急子宫切除的难治性产后出血患者入住重症监护室率更高，更容易出现切口感染等并发症。结论警惕患者的出血原因，早期识别和评估患者的高危因素，分娩前做好充足的准备。鼓励患者阴道分娩，控制剖宫产率有助于减少难治性产后出血中紧急子宫切除的发生。

Risk factors of emergency hysterectomy in refractory postpartum hemorrhage and adverse outcome analysis

Objective To analyze the high-risk factors and adverse outcome of emergency hysterectomy in refractory postpartum hemorrhage. Methods The clinical data of 250 patients with refractory postpartum hemorrhage who were delivered in the obstetrics department of Shenzhen People′s Hospital from January 2009 to July 2019 were retrospectively analyzed. Among them, 78 patients received emergency hysterectomy. Single factor and binary logistic regression analysis were applied to screened high-risk factors for emergency hysterectomy in refractory postpartum hemorrhage and adverse outcome. Results History of previous cesarean section and cesarean delivery were high risk factors for emergency hysterectomy in refractory postpartum hemorrhage (P<0.05). History of previous cesarean section, urgency of cesarean section, preoperative placenta and placenta implantation were high risk factors for emergency hysterectomy of refractory postpartum hemorrhage during cesarean delivery (P<0.05). It was more prevalent of ICU stay in patients received emergency hysterectomy, and so were the complications such as infection of incision. ConclusionEarly identification and assessment of patient with risk factors, adequate preparation before delivery, encouraging vaginal delivery and controlling cesarean delivery could help reducing the incidence of emergency hysterectomy.