基层严重产后出血影响因素分析

【作者】 马亚红；

【导师】 吴久玲；

【作者基本信息】 中国疾病预防控制中心 ， 公共卫生， 2008， 硕士

【摘要】 【背景】严重产后出血是产科严重并发症,与失血性休克、弥漫性血管内凝血、产褥感染、产后贫血、席汉氏综合征、孕产妇死亡密切相关,是我国孕产妇死亡的首位原因。因产后出血导致的孕产妇死亡病例数的80.0%以上发生在基层,占全国孕产妇死亡总数的28%。严重产后出血发生原因复杂,不仅有病理生理因素,还与医疗保健等因素有关。深入探讨基层严重产后出血的影响因素,有利于针对基层医疗服务中存在的问题制定防范措施提供科学依据,以提高基层产科服务质量。【目的】研究基层严重产后出血影响因素,探讨减少基层严重产后出血发生的防治措施,以降低严重产后出血的发生率,改善母婴结局,降低基层地区孕产妇死亡率。【方法】采用病例对照研究方法,在河南省选取郏县所有能够开展助产技术服务的县级医疗保健机构,抽取2006年1月1日至2007年12月31日所有住院分娩符合严重产后出血诊断标准的病例作为病例组,以1:1的比例选取同期住院分娩符合条件的病例作为对照组。采用自行设计的产后出血病历调查表,从研究对象的病历中收集相关信息,调查内容包括对孕产妇的基本情况、孕期保健服务利用情况、本次分娩情况、产后出血抢救措施、妊娠结局等。采用Epidata3.1进行数据录入,使用SPSS for Windows 11.5统计软件包进行数据分析。采用平均值、中位数、构成比、率等进行描述性分析。不同组间均值的比较应用两独立样本t检验(Independen-Samples T Test);各影响因素在病例组与对照组的构成比用χ~2检验;通过非条件多因素Logistic回归分析方法探讨各相关因素与严重产后出血的作用关系。【结果】4所县级医院分娩产妇总数21654例,严重产后出血的发生率为0.42%,由严重产后出血导致子宫切除率是0.16%,是国外报道0.053%的3.0倍;由严重产后出血导致孕产妇死亡数占孕产妇死亡总数的53.9%。对孕前、孕期病理生理因素及医疗保健因素统计分析显示:年龄≥35岁、流产次数≥2次、妊娠合并中重度贫血、胎盘异常、产前检查次数≤4次、引产、产前应用宫缩剂、不良的产程干预、宫口开全后的剖宫产术、产后出血处理时机(出血量≥500ml)、不规范治疗产后出血等因素与基层严重产后出血发生相关;合理的产后预防应用缩宫素是严重产后出血的保护因素。多因素Logistic回归分析显示:产前应用宫缩剂(OR=14.293)、流产≥2次(OR=11.374)、胎盘异常(OR=7.081)、剖宫产(OR=5.389)是严重产后出血的危险因素。产后出血诊断明确后应用欣母沛(OR=0.026)对严重产后出血的发生有保护作用。【结论】本研究揭示与基层严重产后出血发生有关的一些孕前、孕期、产时、产后的影响因素,为制定基层严重产后出血防治措施提供了科学依据。更多还原

【Abstract】 【Background】Severe postpartum hemorrhage is the main reason of causing severe obstetrical complication,hemorrhagic shock,disseminated intravascular coagulation(DIC),postpartum infection,Sheehan’s syndrome and maternal mortality.80%maternal death caused by severe postpartum hemorrhage occurs in grass-roots areas in China,which accurate for 28%of all national cases of maternal death.The reasons of severe postpartum hemorrhage are complicated, which was affected by pathological,physiological and health care factors.In order to provide scientific evidence to prevent the problem and improve the rural health care quality,Analyzing and investigating the influencing factors of severe postpartum hemorrhage is needed.【Object】To analyze the influencing factors of severe postpartum hemorrhage,and to explore prevent measurement of reducing the severe postpartum hemorrhage inorde to improve of maternal and infant outcome and reduce the incidence of maternal morbidity and mortality rate (MMR) in rural area.【Methods】The Case-Control Study method was used in this research.The samples were selected from all of county-level hospitals(4 hospitals) in Jia county of Henan Province.Cases of severe postpartum hemorrhage were taken(from January 1st,2006 to December 31th,2007) as research group,and the cases of control-group were selected according to 1:1 ratio at the same period in the same hospitals.The relevant information of postpartum hemorrhage from case record was collected via the questionnaire designed.The contents of questionnaire included survey object’s social demographic characteristics,history of prenatal health care, delivery care,emergency care of postpartum hemorrhage and pregnancy outcomes.Epidata 3.1 was used to input data,and applied SPSS 11.5 software to conduct statistical analysis.The mean,median,percentage and ratio were used in data description.T-test andχ~2- test were applied in factors analysis in the two groups.Logistic regression was used to investigate the interaction relationship between those factors and severe postpartum hemorrhage.【Result】The total number of living-birth in four hospitals is 21,654.The rate of severe postpartum hemorrhage is 0.42%,and rate of hysterectomy causing by severe postpartum hemorrhage is 0.171%,which is 3.2 times higher than that of international data(0.053%). Death caused by severe postpartum hemorrhage is accurate for 53.9%of the total number of maternal death.The single factor analysis showed that:age＞35,times of abortion≥2, pregnancy with middle and severe anemia,placenta abnormity,times of antenatal check≤4, Induce contractions with Oxytocin,Speeding up the labor process,harmful intervention during labor process,having cesarean section after dilatation of cervix with 10cm,delay opportunity of dealing with hemorrhage(bleeding≥500ml),substandard care of postpartum hemorrhage are associated with severe postpartum hemorrhage.Reasonable and preventive application of Oxytocin and using Carboprost Tromethamine timely are the protective factors.The result of multi-factor logistic regression showed that speeding up the labor process with oxytocin (OR=14.293),times of abortion≥2(OR=11.374),abnormal placenta(OR=7.081),cesarean section(OR=5.389) were important indicators of postpartum hemorrhage,and using Carboprost Tromethamine(OR=0.028) was protective indicator.【Conelusion】This research indicated that the factors exiting in pre-pregnancy,antenatal,labor and delivery period were important impact factors of severe postpartum hemorrhage,and provided scientific evidences for making the strategies of prevention and treatment of severe postpartum hemorrhage.更多还原