產(chǎn)后出血量評估及產(chǎn)后出血相關(guān)因素探討

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1、萬方數(shù)據(jù)目錄論文摘要中文摘要··························································2英文摘要··························································4研究內(nèi)容前言··························································6第一部分實際測量產(chǎn)后出血量與臨床估算產(chǎn)后出血量的比較資料與方法··································

2、·····················7結(jié)果································································9討論·······························································12第二部分產(chǎn)后出血相關(guān)因素的探討資料與方法······················································15結(jié)果································

3、·······························20討論·······························································25結(jié)論·························································29參考文獻·························································30綜述········································

4、·················35致謝·························································42萬方數(shù)據(jù)中文摘要產(chǎn)后出血量的評估及產(chǎn)后出血相關(guān)因素的探討目的：通過實際測量出血量與臨床估算出血量進行比較，旨在說明產(chǎn)后出血量準確測量的重要性；探討產(chǎn)后出血相關(guān)因素及尋求有價值的高危因素評分方法。方法：回顧性研究我院2011年03月30日－2011年05月30日分娩141例孕婦的臨床資料，用體積法+稱重法準確測量產(chǎn)婦產(chǎn)后24小時的出血量，分析其臨床表現(xiàn)、孕期情況、產(chǎn)科合并

5、癥，了解產(chǎn)后出血相關(guān)因素，通過logistic回歸分析篩選出危險因素；并根據(jù)全身因素、人流刮宮史、妊娠期高血壓疾病、前置胎盤/胎盤早剝、宮高、血紅蛋白、血小板、影響凝血機制的疾病、羊水過多/多胎妊娠、妊娠合并子宮肌瘤、產(chǎn)程進展、分娩方式、第三產(chǎn)程時間、胎兒體重、胎盤殘留/滯留/植入等15項相關(guān)因素制成評分表，進行評分。根據(jù)評分值與產(chǎn)后出血的相關(guān)性分析及l(fā)ogistic回歸分析結(jié)果評價該高危因素評分表的臨床價值。結(jié)果：（1）141例孕婦測量24小時平均出血量為418.19±174.08ml，臨床估算產(chǎn)后出血量平均為202.38±

6、92.02ml；實際測量產(chǎn)后出血共27例，產(chǎn)后出血率為19.15%；臨床估算產(chǎn)后出2血共4例，產(chǎn)后出血率為2.84%；兩者產(chǎn)后出血率比較，χ=19.172，P＜0.05，即實際測量產(chǎn)后出血率高于臨床估算出血率。（2）實際測量產(chǎn)后出血量與臨床估算差值呈正相關(guān)關(guān)系，兩者的Spearman相關(guān)系數(shù)r=0.858，P<0.05，即實際產(chǎn)后出血量越多，臨床估算越不準確。(3)通過logistic單因素分析篩選出的危險因素有7個，分別為巨大兒,第三產(chǎn)程時間,疤痕子宮,產(chǎn)程進展,宮高,胎盤粘連、殘留、滯留等,妊娠合并子宮肌瘤。(4)在log

7、istic多因素分析中有5個進入多因素回歸模型，分別為：巨大兒（OR=10.361,95%CI2.966～36.197）；疤痕子宮（OR=6.008,95%CI1.473～24.509）；產(chǎn)程進展（OR=3.518,95%CI1.356～9.131）；胎盤粘連、殘留、滯留等（OR=2.575,95%CI1.346～4.924）；妊娠合并子宮肌瘤（OR=2.181,95%CI1.192～3.991）。(5)產(chǎn)后出血量與高危評分值呈正相關(guān)關(guān)系，兩者的Spearman相關(guān)系數(shù)r=0.591，P<0.05。結(jié)論：（1）產(chǎn)后出血量的準確

8、測量及高危因素評分對預(yù)防產(chǎn)后出血的發(fā)生具有十分重要的意義。（2）產(chǎn)后出血的高危因素包括：巨大兒，疤痕子宮，產(chǎn)程進展，胎盤粘連、殘留、滯留，妊娠合并子宮肌瘤。因此控制巨大兒的發(fā)生，嚴格掌握剖宮產(chǎn)指征、做好計劃生育、3萬方數(shù)據(jù)降低剖宮產(chǎn)率及再次剖宮產(chǎn)的發(fā)生，密切注意產(chǎn)程進展等對于