产后出血量评估及产后出血相关因素探讨

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1、万方数据目录论文摘要中文摘要··························································2英文摘要··························································4研究内容前言··························································6第一部分实际测量产后出血量与临床估算产后出血量的比较资料与方法··································

2、·····················7结果································································9讨论·······························································12第二部分产后出血相关因素的探讨资料与方法······················································15结果································

3、·······························20讨论·······························································25结论·························································29参考文献·························································30综述········································

4、·················35致谢·························································42万方数据中文摘要产后出血量的评估及产后出血相关因素的探讨目的：通过实际测量出血量与临床估算出血量进行比较，旨在说明产后出血量准确测量的重要性；探讨产后出血相关因素及寻求有价值的高危因素评分方法。方法：回顾性研究我院2011年03月30日－2011年05月30日分娩141例孕妇的临床资料，用体积法+称重法准确测量产妇产后24小时的出血量，分析其临床表现、孕期情况、产科合并

5、症，了解产后出血相关因素，通过logistic回归分析筛选出危险因素；并根据全身因素、人流刮宫史、妊娠期高血压疾病、前置胎盘/胎盘早剥、宫高、血红蛋白、血小板、影响凝血机制的疾病、羊水过多/多胎妊娠、妊娠合并子宫肌瘤、产程进展、分娩方式、第三产程时间、胎儿体重、胎盘残留/滞留/植入等15项相关因素制成评分表，进行评分。根据评分值与产后出血的相关性分析及logistic回归分析结果评价该高危因素评分表的临床价值。结果：（1）141例孕妇测量24小时平均出血量为418.19±174.08ml，临床估算产后出血量平均为202.38±

6、92.02ml；实际测量产后出血共27例，产后出血率为19.15%；临床估算产后出2血共4例，产后出血率为2.84%；两者产后出血率比较，χ=19.172，P＜0.05，即实际测量产后出血率高于临床估算出血率。（2）实际测量产后出血量与临床估算差值呈正相关关系，两者的Spearman相关系数r=0.858，P<0.05，即实际产后出血量越多，临床估算越不准确。(3)通过logistic单因素分析筛选出的危险因素有7个，分别为巨大儿,第三产程时间,疤痕子宫,产程进展,宫高,胎盘粘连、残留、滞留等,妊娠合并子宫肌瘤。(4)在log

7、istic多因素分析中有5个进入多因素回归模型，分别为：巨大儿（OR=10.361,95%CI2.966～36.197）；疤痕子宫（OR=6.008,95%CI1.473～24.509）；产程进展（OR=3.518,95%CI1.356～9.131）；胎盘粘连、残留、滞留等（OR=2.575,95%CI1.346～4.924）；妊娠合并子宫肌瘤（OR=2.181,95%CI1.192～3.991）。(5)产后出血量与高危评分值呈正相关关系，两者的Spearman相关系数r=0.591，P<0.05。结论：（1）产后出血量的准确

8、测量及高危因素评分对预防产后出血的发生具有十分重要的意义。（2）产后出血的高危因素包括：巨大儿，疤痕子宫，产程进展，胎盘粘连、残留、滞留，妊娠合并子宫肌瘤。因此控制巨大儿的发生，严格掌握剖宫产指征、做好计划生育、3万方数据降低剖宫产率及再次剖宫产的发生，密切注意产程进展等对于