427例异位妊娠发生的危险因素分析

发布时间：2018-07-03 15:18

本文选题：异位妊娠 + 危险因素　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：异位妊娠属于急腹症，在妇科中很常见。不仅女性的身体健康会因此遭受危害，而且以后的妊娠情况也可能为此产生不良影响。近些年来，异位妊娠在国内外文献中被广泛报导。可以发现它的发生率有不断上涨的趋势。异位妊娠是孕产妇在受孕头三个月中死亡的重要原因。而且人们的生活习惯和生活方式的改变在一定程度上也影响了异位妊娠的患病相关因素。我们发现，不同国家和地区的发病危险因素并不完全相同，这提示我们有些异位妊娠的危险因素是可以通过干预而加以改变的。为此，本文深入探究异位妊娠的危险因素，争取为女性提供有效的一些预防办法。从而达到使异位妊娠发生率下降的目的。方法：本文回顾性分析了2009年1月至2013年11月大连医科大学附属第二医院妇产科收治的确诊为异位妊娠的住院患者427例，年龄18-45岁，，中位年龄为30岁，其中包括输卵管妊娠406例，卵巢妊娠4例，宫颈妊娠8例，宫角部妊娠7例，剖宫产瘢痕部位妊娠2例。对所选病例采用病例对照研究，另随机选取同一时间段住院的300例患者。这300例为正常妊娠妇女，年龄22-43岁，中位年龄为28岁，作为本次研究的对照组。统计数据均选用SPSS19.0软件进行统计分析。对年龄等计量资料，选用均数和标准差来表示。对吸烟、月经紊乱、子宫肌瘤、流产、盆腔炎性疾病、异位妊娠和下腹部手术历史等计数资料采用卡方检验或连续性校正卡方检验进行统计学分析。P0.05时差异有统计学意义。采用非条件Logistic回归分析中的后退逐步回归法，分析有统计学意义的因素。了解它们与异位妊娠发生的相关性。结果：1.异位妊娠发病的年龄主要集中在20-40岁。2.异位妊娠发病相关危险因素的单因素分析：流产史、盆腔炎性疾病史、下腹部手术史及异位妊娠史在异位妊娠患者和正常妊娠妇女之间的差异有统计学意义（P0.05），是异位妊娠发病的危险因素。吸烟史、子宫肌瘤和月经紊乱史在异位妊娠患者和正常妊娠患者之间的差异无统计学意义（P0.05），不是异位妊娠发病的危险因素。3.异位妊娠发病相关危险因素的多因素分析：（1）盆腔炎性疾病史、异位妊娠史和下腹部手术史对异位妊娠的发病有明显影响，是异位妊娠发病的独立危险因素。（2）盆腔炎性疾病史、异位妊娠史和下腹部手术史均与异位妊娠的发病成正相关。（3）异位妊娠发病的独立危险因素按风险从高到低依次为：盆腔炎性疾病史（OR=5.915）、异位妊娠史(OR=3.470)、下腹部手术史(OR=2.343)。结论：1.异位妊娠的发病年龄主要集中在20-40岁，该阶段的女性出现停经史应尤为注意。2.流产史、盆腔炎性疾病史、异位妊娠史和下腹部手术史是异位妊娠的危险因素，其中盆腔炎性疾病史、异位妊娠史和下腹部手术史是独立危险因素。注意性生活卫生，避免意外怀孕，减少流产次数，规范盆腔手术操作等可以减少异位妊娠发生的风险。
[Abstract]:Objective: ectopic pregnancy belongs to acute abdomen and is very common in gynecology. Not only are women's health jeopardized, but later pregnancies can also be adversely affected. In recent years, ectopic pregnancy has been widely reported in the literature at home and abroad. It can be found that the incidence of a rising trend. Ectopic pregnancy is an important cause of maternal death in the first three months of pregnancy. To some extent, the change of people's living habits and lifestyle also affects the related factors of ectopic pregnancy. We found that the risk factors for ectopic pregnancy were not the same in different countries and regions, suggesting that some of the risk factors of ectopic pregnancy could be changed by intervention. Therefore, this paper explores the risk factors of ectopic pregnancy and tries to provide some effective prevention methods for women. Thus, the incidence of ectopic pregnancy decreased. Methods: from January 2009 to November 2013, 427 patients with ectopic pregnancy, aged 18-45 years, with a median age of 30 years, were retrospectively analyzed in the Department of Gynecology and Obstetrics, second affiliated Hospital of Dalian Medical University. There were 406 cases of tubal pregnancy, 4 cases of ovarian pregnancy, 8 cases of cervical pregnancy, 7 cases of uterine corner pregnancy and 2 cases of cesarean scar pregnancy. A case-control study was conducted and 300 patients in the same time period were randomly selected. The 300 normal pregnant women, aged 22-43, with a median age of 28, served as controls. SPSS 19.0 software was used for statistical analysis. For age and other measurement data, use the mean and standard deviation to express. For smoking, menstrual disorders, uterine leiomyoma, abortion, pelvic inflammatory diseases, ectopic pregnancy and lower abdominal surgery history of counting data using chi-square test or continuity correction chi-square test statistical analysis. The regressive stepwise regression method in non-conditional logistic regression analysis was used to analyze the statistically significant factors. To understand their association with ectopic pregnancy. The result is 1: 1. The age of ectopic pregnancy is mainly 20-40 years old. Univariate analysis of risk factors associated with ectopic pregnancy: history of abortion, history of pelvic inflammatory disease, The history of lower abdominal surgery and ectopic pregnancy were significantly different between ectopic pregnancy and normal pregnant women (P0.05), which was the risk factor of ectopic pregnancy. Smoking history, hysteromyoma and menstrual disorder history between ectopic pregnancy patients and normal pregnancy patients had no statistical significance (P0.05), is not the risk factor of ectopic pregnancy. 3. Multivariate analysis of risk factors related to ectopic pregnancy: (1) history of pelvic inflammatory disease, history of ectopic pregnancy and history of lower abdominal surgery were independent risk factors of ectopic pregnancy. (2) history of pelvic inflammatory disease. The history of ectopic pregnancy and the history of lower abdominal surgery were positively correlated with the incidence of ectopic pregnancy. (3) the independent risk factors of ectopic pregnancy were: history of pelvic inflammatory disease (OR5.915), history of ectopic pregnancy (OR3.470), history of lower abdominal surgery (OR2.343). Conclusion 1. The onset age of ectopic pregnancy is mainly 20 to 40 years old. The history of menopause in women in this stage should be paid more attention to. 2. 2. History of abortion, history of pelvic inflammatory disease, history of ectopic pregnancy and history of lower abdominal surgery were risk factors of ectopic pregnancy, among which history of pelvic inflammatory disease, history of ectopic pregnancy and history of lower abdominal surgery were independent risk factors. Attention to sexual hygiene, avoid unwanted pregnancy, reduce the number of abortions, standardized pelvic surgery can reduce the risk of ectopic pregnancy.
【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】：R714.22

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