产科急症子宫切除术相关因素的分析

目的讨论产科急症子宫切除术患者相关危险因素的分析,探讨子宫切除的时机和指征降低子宫切除率的可行方法。方法回顾性分析了2001年1月到2010年12月期间,某院收治的产科急症子宫切除的患者70例作为观察组,并且选择同期收治的68例剖宫产产后出血子宫未切除患者作为对照组。自行设计调查表,观察组和对照组分别从前置胎盘、胎盘早剥、子宫收缩乏力、子宫破裂、弥散性血管内凝血(DIC)、晚期产后出血、子宫肌瘤、疤痕子宫、宫腔感染、羊水过多、巨大儿等方面进行调查,分别采用单变量(χ2检验)进行对比,筛选出与子宫切除术有关因素。以及多变量(条件Logistic回归)方法筛选出主要危险因素。结果单因素分析显示病例组与对照组之间在前置胎盘(P﹤0.05)、胎盘早剥(P﹤0.05)、胎盘植入(P﹤0.05)、子宫破裂(P﹤0.05)、DIC(P﹤0.05)、出血量多(P﹤0.05)、子宫肌瘤(P﹤0.05)这7个方面差异有统计学意义;多因素条件Logistic回归显示只有前置胎盘(P﹤0.05)、胎盘早剥(P﹤0.05)、胎盘植入(P﹤0.05)、子宫破裂(P﹤0.05)、DIC(P﹤0.05)5个因素显示是危险因素,与子宫切除密切相关。结论子宫切除术与多种因素有关,加强对妇女患者的监测、提高警惕、减少子宫切除术的发生

Analysis of related factors of emergency obstetric hysterectomy

OBJECTIVE To analyze the related risk factors of uterine resection,to discuss feasible method timing and indications for lowering rate of hysterectomy.METHODS A retrospective analysis from January 2001 to December 2010,70 cases of emergency hysterectomy patients in our hospital were as the observation group,and selected 68 cases of patients with postpartum bleeding but uterus was not resected as the control group in the same period.Used self-designed questionnaire,compared the placenta praevia,placental abruption,uterine atony,uterine rupture,disseminated intravascular coagulation(DIC),late postpartum hemorrhage,uterine fibroids,uterine scar,intrauterine infection,polyhydramnios,fetal macrosomia in the observation group and control group.Then used single variable(χ2 test)and multivariable(conditional logistic regression)to select related factors of hysterectomy.RESULTS The univariate analysis revealed placenta previa(P﹤0.05),placental abruption(P﹤0.05),placental implantation(P﹤0.05),uterine rupture(P﹤0.05),DIC(P﹤0.05),the amount of bleeding(P﹤0.05),uterine fibroids(P﹤0.05)in both groups were different.The multifactorial conditions logistic regression revealed only placenta praevia(P﹤0.05),placental abruption(P﹤0.05),placental implantation(P﹤0.05),uterine rupture(P﹤0.05),DIC(P﹤0.05)were the risk factors,and these above were closely related to the hysterectomy.CONCLUSION Hysterectomy is associated with many factors,it should strengthen monitoring on female patients,higher alertness to reduce the occurrence of hysterectomy.