1707例产后出血患者产前高危因素及出血原因分析

目的 探讨导致产后出血的高危因素及原因.方法 对1999～2008年间江苏省5家医院的1707例产后出血病例资料进行回顾性统计分析,评价产后出血的高危因素、出血原因和出血量的差异.结果 ①流产史、前置胎盘、妊娠期高血压疾病等高危因素在产后出血中所占比例分别为55.1％、17.9％、15.9％；有高危因素者产后出血量（782.3±683.3） mL]明显多于无高危因素者（571.0±225.7） mL],二者比较差异有统计学意义（P＜0.05）.②剖宫产的平均出血量（836.2±763.2）mL]和阴道分娩的平均出血量（634.1±377.1）mL]比较,差异有统计学意义（P＜0.05）.③1707例产后出血原因依次为子宫收缩乏力、胎盘因素、软产道损伤、凝血功能障碍,宫缩乏力导致的产后出血量与软产道损伤导致的产后出血量差异无统计学意义（P=0.831）；胎盘因素与凝血功能障碍所致出血量差异有统计学意义（P＜0.05）.④86.0％（1468/1707）的产后出血发生在产后2h内.结论 ①有高危因素者产后出血量明显多于无高危因素者；②剖宫产产后出血患者出血量明显多于阴道分娩者；③子宫收缩乏力仍然是产后出血的主要原因,胎盘因素及凝血功能障碍导致的产后出血量明显多于子宫收缩乏力及软产道损伤导致的出血量.

Analysis of high risk factors and causes of 1707 cases postpartum hemorrhage

Objective To explore the risk factors and the causes of postpartum hemorrhage. Methods All 1707 cases of postpartum hemorrhage in 5 hospitals in Jiangsu Province from 1999 to 2008 were collected and retrospectively an- alyzed. Risk factors of postpartum hemorrhage, bleeding reasons and blood loss amount were estimated. Results （1）The percent of history of abortion, hypertensive disorder complicating pregnancy and placental abruption of postpartum hemorrhage were 55.1%, 17.9% and 15.9% respectively. The blood loss of pregnant women with high risk factors （782.3±683.3） mL] were significantly higher than those without high risk factors （571.0±225.7） mL] （P 〈 0.05）. （2）There were statistical differences in blood loss between cesarean section （836.2±763.2） mL] and vaginal delivery （634.1± 377.1） mL] （P 〈 0.05）. （3）Uterine atony, placenta factor, obstetric trauma and coagulation defects were the 4 main causes of the 1707 cases postpartum hemorrhage. There was no statistical significance of postpartum haemorrhage amount differences between uterine atony and obstetric trauma groups. There was significant differences in blood loss between placenta factor group and blood coagulation dysfunction group. （4）Most postpartum hemorrhage （86.0%, 1468/ 1707） were occurred in 2 hours. Conclusion （1）The blood loss of pregnant women with high risk factors is significantly higher that of pregnant women with no high risk factors. （2）The blood loss of cesarean section patients is more than that of vaginal delivery patients. （3）Uterine atony is still the main cause of postpartum hemorrhage. The blood loss of postpartum hemorrhage caused by placental factors and coagulation defects are significantly higher than those of uter- ine atony and obstetric trauma.