产后出血量的评估及产后出血相关因素的探讨-妇产科学专业论文.docxVIP

万方数据 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 ······················································· 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 ·······························································20 讨论 ·······························································25 结 论 ·························································29 参考文献 ·························································30 综 述 ·························································35 致 谢 ·························································42 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±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 血共 4 例，产后出血率为 2.84%；两者产后出血率比较，χ2=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，P0.05，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 logistic 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%CI 2.966 ～ 36.197）；疤痕子宫（OR= 6.008, 95%CI 1.473 ～ 24.509）；产程进展（OR= 3.518, 95%CI 1.356 ～ 9.131）；胎盘粘连、残留、滞留等（OR= 2.575, 95%CI 1.346 ～ 4.924）；妊娠合并子宫肌瘤（OR= 2.181, 95%CI 1.192 ～ 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， P0.05。 结论：（1）