产后出血180例相关因素分析及护理

目的分析、研究产后出血的影响因素，以便临床指导产后出血的综合护理。方法分析唐山市乐亭县医院产后出血180例（产后出血组）以及同期非产后出血产妇360例（对照组），比较二组与产后出血有关的各个因素的差异，分析产后出血发生原因及护理体会。结果2010年5月～2013年11月，乐亭县医院共分娩2802例，产后出血者180例，产后出血的发生率6．42％。与产后出血有关的因素包括：高龄（年龄≥35岁）、肥胖（体重指数≥24）产次≥2次、前置胎盘和胎盘早剥、妊娠高血压疾病和妊娠期糖尿病、多胎、巨大儿、剖宫产、阴道助产。产后出血组中胎盘因素（粘连或植入或残留）、软产道裂伤及宫缩乏力的发生率高于对照组，组间比较差异有统计学意义。多因素分析显示，宫缩乏力、胎盘因素、软产道裂伤、胎儿体重≥4000g、剖宫产、产次≥2次与产后出血有关。结论及时发现高危因素，重点关注高危因素孕妇，正确处理产程，严密观察病情，及时发现产后出血并尽快处理，改善预后。

NURSING EXPERIENCE ON 180 CASES OF POSTPARTUM HEMORRHAGE

Objective To study the influencing factors of postpartum hemorrhage and explore the nursing strategies for the patients. Methods Totally 180 cases of postpartum hemorrhage as well as 360 cases of non- postpartum hemorrhage during the same time were analyzed. In order to make clear the influencing factors of postpartum hemorrhage and give advice on nursing, all the factors related to postpartum hemorrhage such as age, delivery mode, complications from the patients were compared between the two groups. Results There were 2802 cases in this hospital from May 2010 to Nov 2013, and 180 cases of postpartum hemorrhage, the incidence rate of postpartum hemorrhage was 6.42 %. Factors associated with postpartum hemorrhage included： advanced age（age above 35 years old）, obesity （BMI ≥ 24）, produce more than 2 times, placenta previa, placental abruption, pregnancy-induced hypertension disease, and gestational diabetes, multiplets, macrosomia and cesarean section and vaginal midwifery. Placental factors of postpartum hemorrhage group （adhesion or implanted or residual）, soft birth canal laceration and the incidence of contractions fatigue were higher than those in the control group. Multi- factor analysis showed that the contractions fatigue, placental factors, soft birth canal laceration, fetal weight ≥4 000g, cesarean section, produce ≥2 were associated with postpartum hemorrhage. Conclusion We should pay enough attention to postpartum hemorrhage. Not only the risk factors for postpartum hemorrhage are founded, but also heavy bleeding is identified on time and handle as soon as possible, which all can improve the prognosis.