【作者】 耿岩；

【导师】 刘锡梅；

【作者基本信息】 山东大学 ， 妇产科学， 2006， 硕士

【摘要】 目的：分析产后出血的危险因素，探讨产后出血的防治措施。 方法：对齐鲁医院1999～2003年共148例产后出血病例(研究组)进行回顾性分析，对产妇的年龄、体重指数、孕周、孕产次、流产次数、胎儿数、分娩方式、产程、胎儿体重、产后出血量、产后出血发生时间、出血原因、治疗措施及转归等多项指标进行观察；同时以2∶1的比例随机选取同期非产后出血孕妇296例作为对照组，通过多因素Logistic回归分析筛选出与产后出血相关的主要危险因素。还分析总结了产后出血的处理方法。 结果：5年的纠正产后出血率为1.38％(137／9925)。2002年和其他各年间产后出血率有极显著性差异(P＜0.01)，其他各年间无显著性差异(P＞0.05)。发生在产后2h内者128例，占86.49％。宫缩乏力108例，占72.97％。胎盘因素17例，占11.49％。凝血功能异常12例，占8.11％。软产道裂伤11例，占7.43％。发生失血性休克14例，其中外院转入7例。行双侧子宫动脉结扎术1例，双侧髂内动脉结扎术1例，双侧子宫动脉结扎加双侧髂内动脉结扎术1例，子宫切除术3例，死亡2例。对产后出血的高危因素进行单因素分析，有17个因素有统计学意义；多因素Logistic回归分析显示对产后出血影响最大的依次为前置胎盘(OR=20.459)、宫缩乏力(OR=17.533)、软产道裂伤(OR=16.235)、胎盘因素(OR=14.842)、胎儿体重≥4000g(OR=13.056)、第三产程≥10min(OR=6.930)、剖宫产(OR=3.041)、子痫前期(OR=2.786)及早接触早吸吮(OR=0.081)。 结论：产后出血是产科的严重并发症之一。宫缩乏力是引起产后出血的首要因素，减少巨大儿和多胎妊娠的发生对减少产后出血具有重要意义。胎盘因素是引起产后出血的第二病因，是导致产科子宫切除的首要原因。加强计划生育宣教，减少产前的非意愿性妊娠及流产而致的子宫内膜损伤，提倡少生优生，可减少胎盘因素所致产后出血的发生。加强产前、产时及产后对产后出血的预防；严格掌握剖宫产指征，降低剖宫产率；提高手术技巧，避免意外损伤，是减少产后更多还原

【Abstract】 Objective: To investigate the risk factors of postpartum hemorrhage (PPH) and to explore the better methods of prevention and treatment.Methods: Clinical data of 148 cases of PPH (research group) hospitalized from 1999 to 2003 in QiLu hospital were retrospectively analyzed. The following items were investigated : age、body mass index、 gestational weeks、etiological factors> volume of blood loss、abortion history、the number of parturition and fetus、fetus weight、delivery manner、prevention and treatment; We also collected the other 296 non-PPH cases over the 5 years randomly as control group, high risk factors were analyzed using logistic regression by SPSS statistical software. The treatment methods of postpartum hemorrhage in our hospital were also summarized.Results: The corrective PPH rate over the 5 years is 1.38%(137/9925). The PPH rate of 2002 was significantly lower than the other years, and no difference between the other years. 128 cases happened in 2 hrs after delivery(86.49%).The primary cause was uterine inertia (72.97%), and the second was placenta factor(11. 49%), the third was blood coagulation disorder (8.11%), the last was soft birth canal injury (7. 43%). There were 14 cases hemorrhagic shock, of which 7 cases were transmitted from the other hospitals. In all 148 patients, bilateral uterine artery ligation was performed in 1 case, bilateral hypogastric artery ligation in 1 case, uterine and hypogastric artery ligation in 1更多还原