351例产后出血临床分析及严重产后出血预测评分表的建立

发布时间：2018-05-31 10:50

本文选题：产后出血 + 危险因素　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的分析产后出血(postpartum hemorrhage，PPH)发生的危险因素，建立严重产后出血预测评分表，，为阐明产后出血病因以及评估严重产后出血发生风险提供依据。方法采用大样本回顾性分析的流行病学方法，选取2009年01月-2012年12月期间于北京军区总医院妇产科住院分娩救治的产后出血患者351人作为观察对象，另选取同期分娩未发生产后出血的孕妇351人作为对照。采集两组孕妇的相关参数：1、人口学特征：产妇的年龄、分娩时孕龄、孕次、产次、新生儿出生体重等；2、妊娠相关特征性参数：分娩方式、产后出血量、胎盘粘连、前置胎盘、胎盘胎膜残留、妊娠期高血压疾病、产程图、胎数等。采用独立样本t检验、x2检验、秩和检验以及logistic回归分析等统计学方法研究产后出血和严重产后出血发生的相关危险因素；根据统计结果找出产后出血和严重产后出血的高危因素，对其进行量化评分，建立预测评分表；采用logistic回归建立产后出血和严重产后出血风险预测回归方程。结果 1.产后出血发生的相关危险因素分析：（1）单因素分析显示：观察组孕妇所生新生儿出生体重较对照组显著升高（P＜0.05）；观察组孕妇孕周37周、剖宫产分娩、胎盘粘连、巨大胎儿、胎盘植入、前置胎盘、妊娠期高血压疾病、多胎妊娠的发生率较对照组显著升高（P＜0.05）；（2）多因素回归分析显示：孕周分组、分娩方式、胎盘粘连、新生儿体重、前置胎盘5个因素进入回归模型；按OR值大小顺次为胎盘粘连、前置胎盘、孕周分组、分组方式、新生儿体重。 2.严重产后出血发生的相关危险因素分析：（1）单因素分析显示：严重产后出血孕妇中年龄≥35岁、前置胎盘、胎盘植入的发生率均较轻度产后出血孕妇显著升高，两组间分娩方式构成比例不同（P＜0.05）。（2）多因素回归分析显示：年龄分组、分娩方式、胎盘植入3个因素进入回归模型；按OR值大小顺次为胎盘植入、年龄分组和分娩方式。 3.产后出血风险预测：根据自制的严重产后出血预测评分表，经Logistic回归分析，得出产后出血风险预测回归方程为P=exp（-0.858＋0.443*产后出血预测评分）/（1＋exp（-0.858＋0.443*产后出血预测评分））；当产后出血预测评分为6分时产后出血的可能的发生率为48.51%；同样根据严重产后出血预测评分表，经Logistic回归分析，得出严重产后出血风险预测回归方程为P=exp（-3.068＋0.155*产后出血预测评分+0.380*严重产后出血预测评分）/（1＋exp（-3.068＋0.155*产后出血预测评分+0.380*严重产后出血预测评分））；当产后出血预测评分为6分且严重产后出血预测评分为5分时严重产后出血的可能的发生率为44.07%；产后出血预测评分与产后出血发病率呈正相关（r=0.353，P=0.00）。结论 1.胎盘粘连、前置胎盘、孕周分组、巨大胎儿、分娩方式、胎盘植入、妊娠期高血压疾病和胎数是引起产后出血的危险因素，其中胎盘粘连、前置胎盘、孕周分组、分娩方式和新生儿体重是产后出血的独立危险因素。 2.年龄、分娩方式、胎盘植入、前置胎盘是引起严重产后出血的危险因素，其中年龄、分娩方式、胎盘植入是严重产后出血的独立危险因素。 3.预测评分表对于筛查可能发生产后出血及严重产后出血的病例具有临床应用意义，对评分高的孕产妇进行及早的干预治疗，可能对降低产后出血的发生具有积极影响。
[Abstract]:objective
To analyze the risk factors of postpartum hemorrhage (postpartum hemorrhage, PPH) and establish a serious postpartum hemorrhage prediction score table, which provides the basis for clarifying the cause of postpartum hemorrhage and assessing the risk of severe postpartum hemorrhage.
Method
The epidemiological methods of large sample retrospective analysis were used to select 351 postpartum haemorrhage patients in the Department of Obstetrics and Gynecology of General Hospital of Beijing Military Region during the period of 01 months of 2009 -2012 year and December. 351 of the pregnant women who had not produced postpartum hemorrhage in the same period were selected as the control. The related parameters of two groups of pregnant women were collected: 1, people. Oral characteristics: maternal age, birth time, pregnancy, birth, birth weight, birth weight, etc.; 2, pregnancy related characteristic parameters: delivery mode, postpartum hemorrhage, placental adhesion, placenta previa, placenta and fetal membrane residue, pregnancy induced hypertension, labor history, fetal number and so on. Independent sample t test, X2 test, rank sum test and logisti C regression analysis and other statistical methods were used to study the risk factors associated with postpartum hemorrhage and severe postpartum hemorrhage. According to the statistical results, the risk factors of postpartum hemorrhage and severe postpartum hemorrhage were found, the quantitative scores were evaluated, the prediction score was set up, and the risk of postpartum hemorrhage and severe postpartum hemorrhage was established by logistic regression. Equation.
Result
1. analysis of related risk factors of postpartum hemorrhage: (1) single factor analysis showed that the birth weight of pregnant women in the observation group was significantly higher than that of the control group (P < 0.05); the pregnant women in the observation group were pregnant 37 weeks, Caesarean birth, placental adhesion, fetal macrosomia, placenta implantation, placenta previa, pregnancy induced hypertension and multiple pregnancy. The rate was significantly higher than that in the control group (P < 0.05); (2) multiple regression analysis showed that 5 factors of pregnancy week, delivery mode, placental adhesion, newborn weight, and placenta previa entered the regression model, and placental adhesion, placenta previa, gestational week group, grouping mode, newborn weight according to the OR value.
2. analysis of the related risk factors of severe postpartum hemorrhage: (1) single factor analysis showed that the age of pregnant women with severe postpartum hemorrhage was more than 35 years old, placenta previa, placental implantation rate was significantly higher than that of pregnant women with mild postpartum hemorrhage, and the proportion of delivery modes in the two groups was different (P < 0.05). (2) multiple regression analysis showed that age points were: Group, delivery mode, placenta implantation 3 factors into the regression model; according to OR value, placenta implantation, age grouping and delivery mode.
3. risk prediction of postpartum hemorrhage: according to the self-made severe postpartum hemorrhage prediction score, after Logistic regression analysis, the regression equation of postpartum hemorrhage risk was calculated to be P=exp (- 0. 8. 8 +. 4, 4, 4, postpartum hemorrhage prediction score) / (1 + ex P (- 0. 8. 8 +. 4. 4. 4) postpartum hemorrhage). The possible incidence was 48.51%; also based on the severe postpartum hemorrhage prediction score, the Logistic regression analysis showed that the regression equation for the risk of severe postpartum hemorrhage was P=exp (- 3. 0. 0. 6 +. 15 5 * postpartum hemorrhage prediction score of +0.380* severe postpartum hemorrhage) / (1 + ex (- 3. 0. 6 +. 15 5 *) postpartum hemorrhage prediction score of +0.380* serious birth The incidence of severe postpartum hemorrhage was 44.07% when the postpartum hemorrhage prediction score was 6 and the severe postpartum hemorrhage prediction score was 5, and the postpartum hemorrhage prediction score was positively correlated with the incidence of postpartum hemorrhage (r=0.353, P=0.00).
conclusion
1. Placenta Adhesion, placenta previa, grouping of gestational weeks, fetal macrosomia, delivery mode, placenta implantation, pregnancy induced hypertension and fetal number are risk factors for postpartum hemorrhage. Placental adhesion, placenta previa, gestational weeks, delivery mode and newborn weight are independent risk factors for postpartum hemorrhage.
The 2. age, mode of delivery, placenta implantation, and placenta previa are risk factors for severe postpartum hemorrhage, of which age, mode of delivery, and placental implantation are independent risk factors for severe postpartum hemorrhage.
The 3. prediction score table is of clinical significance for the screening of cases of postpartum hemorrhage and severe postpartum hemorrhage. The early intervention treatment for high grade pregnant and parturient may have a positive effect on reducing the occurrence of postpartum hemorrhage.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.461

【参考文献】