產(chǎn)后出血量的評(píng)估及產(chǎn)后出血相關(guān)因素的探討

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1、分類號(hào)：R714.256學(xué)校代碼：10392學(xué)科專業(yè)代碼：100211學(xué)號(hào)：1210305098福建醫(yī)科大學(xué)碩士研究生畢業(yè)論文產(chǎn)后出血量的評(píng)估及產(chǎn)后出血相關(guān)因素的探討Assessmentoftheamountofbloodlossandriskfactorsofpostpartumhemorrhage學(xué)位類型：醫(yī)學(xué)碩士所在學(xué)院：第一臨床醫(yī)學(xué)院研究生：戴秋蘭學(xué)科、專業(yè)：婦產(chǎn)科學(xué)導(dǎo)師：胡繼芬教授研究起止日期：2010年8月至2012年4月答辯日期：2012年05月29日二○一二年五月萬(wàn)方數(shù)據(jù)萬(wàn)方數(shù)據(jù)目錄論文摘要中文摘要·····································

2、·····················2英文摘要··························································4研究?jī)?nèi)容前言··························································6第一部分實(shí)際測(cè)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·······················································7結(jié)果··························································

3、······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·······························································20討論·······························································25結(jié)論···········

4、··············································29參考文獻(xiàn)·························································30綜述·························································35致謝·························································42萬(wàn)方數(shù)據(jù)中文摘要產(chǎn)后出血量的評(píng)估及產(chǎn)后出血相關(guān)因素的探討目的：通過(guò)實(shí)際測(cè)量出血量與臨床估算出血量進(jìn)行比較，旨在說(shuō)明產(chǎn)后出血量準(zhǔn)確

5、測(cè)量的重要性；探討產(chǎn)后出血相關(guān)因素及尋求有價(jià)值的高危因素評(píng)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(zhǔn)確測(cè)量產(chǎn)婦產(chǎn)后24小時(shí)的出血量，分析其臨床表現(xiàn)、孕期情況、產(chǎn)科合并癥，了解產(chǎn)后出血相關(guān)因素，通過(guò)logistic回歸分析篩選出危險(xiǎn)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(jī)制的疾病、羊水過(guò)多/多胎妊娠、妊娠合并子宮肌瘤、產(chǎn)程進(jìn)展、分娩方式、第三產(chǎn)程時(shí)間、胎兒體重、胎盤殘留/滯留/植入等15項(xiàng)相關(guān)因素制成評(píng)分表，進(jìn)行評(píng)分。根據(jù)評(píng)分值與產(chǎn)后出血的相關(guān)性分

6、析及l(fā)ogistic回歸分析結(jié)果評(píng)價(jià)該高危因素評(píng)分表的臨床價(jià)值。結(jié)果：（1）141例孕婦測(cè)量24小時(shí)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±92.02ml；實(shí)際測(cè)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(shí)際測(cè)量產(chǎn)后出血率高于臨床估算出血率。（2）實(shí)際測(cè)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(shí)際產(chǎn)后出血量越多，臨床估算越不準(zhǔn)確。(3)通過(guò)logistic單因素分析篩選出的危險(xiǎn)因

7、素有7個(gè)，分別為巨大兒,第三產(chǎn)程時(shí)間,疤痕子宮,產(chǎn)程進(jìn)展,宮高,胎盤粘連、殘留、滯留等,妊娠合并子宮肌瘤。(4)在logistic多因素分析中有5個(gè)進(jìn)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(jìn)展（OR=3.518,95%CI1.356～9.131）；胎盤粘連、殘留、滯留等（OR=2.575,95%CI1.346～