上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (4): 409-414.doi: 10.3969/j.issn.1674-8115.2022.04.002

• 高危妊娠专题 • 上一篇    下一篇

难治性产后出血导致子宫切除的危险因素分析

胡佳宁1(), 张锦文1, 刘晓瑞1, 陈彩莲2, 林羿1()   

  1. 1.上海交通大学医学院附属国际和平妇幼保健院中心实验室，上海市胚胎源性疾病重点实验室，上海交通大学医学院出生缺陷与罕见病临床研究院，上海 200030
    2.上海交通大学电子信息与电子工程学院自动化系，系统控制与信息处理教育部重点实验室，上海 200240
  • 收稿日期:2021-11-18 接受日期:2022-01-10 出版日期:2022-04-28 发布日期:2022-04-28
  • 通讯作者: 林羿 E-mail:jeanine_1997@163.com;yilinonline@126.com
  • 作者简介:胡佳宁（1997—），女，硕士生；电子信箱：jeanine_1997@163.com。
  • 基金资助:
    国家重点研发计划(2018YFC1002800);国家自然科学基金(82171669);上海交通大学“交大之星”（STAR）计划重大项目(20210201)

Analysis of risk factors of hysterectomy caused by intractable postpartum hemorrhage

HU Jianing1(), ZHANG Jinwen1, LIU Xiaorui1, CHEN Cailian2, LIN Yi1()   

  1. 1.Central Laboratory of The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Embryo Original Diseases; Institute of Birth Defects and Rare Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
    2.Department of Automation, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University; Key Laboratory of System Control and Information Processing, Ministry of Education, Shanghai 200240, China
  • Received:2021-11-18 Accepted:2022-01-10 Online:2022-04-28 Published:2022-04-28
  • Contact: LIN Yi E-mail:jeanine_1997@163.com;yilinonline@126.com
  • Supported by:
    National Key R&D Program of China(2018YFC1002800);National Natural Science Foundation of China(82171669);Shanghai Jiao Tong University Trans-Med Awards Research (Major Project)(20210201)

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摘要：

目的·探讨难治性产后出血导致产科急症子宫切除的危险因素以及相关预防措施。方法·回顾性分析2014年1月—2020年12月于上海交通大学医学院附属国际和平妇幼保健院收治的110 934例产妇的临床资料。根据收治时间，选择其中2015—2017年段（n=48 984）和2018—2020年段（n=45 262）的产妇为研究对象，分析其产科急症子宫切除发生率的情况；选择其中发生难治性产后出血的108例产妇为研究对象，根据是否行子宫切除，将其分为子宫切除组（n=22）与子宫保留组（n=86），采用单因素分析及多因素Logistic回归模型对该2组患者的临床资料进行比较分析，并探究产科急症子宫切除的危险因素。结果·与2015—2017年段相比，2018—2020年段的产科急症子宫切除发生率下降（P=0.039）；与子宫保留组相比，子宫切除组患者的年龄偏大，孕次≥2次、单胎妊娠、发生妊娠合并症（前置胎盘、胎盘植入、瘢痕子宫等）、羊水栓塞者的占比均较高，产后出血量更大（均P<0.05）。多因素Logistic回归分析显示，患者的年龄、产后出血量均是难治性产后出血导致产科急症子宫切除的独立危险因素（P<0.05）。结论·难治性产后出血产妇的年龄越高、出血量越大，越容易导致产科急症子宫切除的发生。临床上需尽早开展监测并进行干预，以降低该类患者产科急症子宫切除的发生率。

关键词: 难治性产后出血, 产科急症子宫切除, 临床特征

Abstract:

Objective·To investigate the risk factors and related preventive measures of intractable postpartum hemorrhage which leads to emergency peripartum hysterectomy.

Methods·The clinical data of 110 934 pregnant women treated in the International Peace Maternal & Child Health Hospital, Shanghai Jiao Tong University School of Medicine from January 2014 to December 2020 were analyzed retrospectively. According to the treated time, pregnant women in the 2015?2017 year-period (n=48 984) and 2018?2020 year-period (n=45 262) were selected as the research objects to analyze the incidence of emergency peripartum hysterectomy. Besides, a total of 108 pregnant women with intractable postpartum hemorrhage were selected as the research objects. The patients were divided into the uterine-removed group (n=22) and the uterine-preserved group (n=86) according to whether they had hysterectomy. The clinical data of the two groups were compared and analyzed by univariate analysis and multivariate Logistic regression model, and the risk factors of emergency peripartum hysterectomy were explored.

Results·Compared with the 2015?2017 year-period, the incidence of emergency peripartum hysterectomy decreased in the 2018?2020 year-period (P=0.039). Meanwhile, compared with the uterine-preserved group, the pregnant women in the uterine-removed group were older, with more than 2 pregnancies, monocyesis, pregnancy complications (placenta previa, placenta implantation, scarred uterus, etc.), amniotic fluid embolism and greater postpartum hemorrhage (all P<0.05). Multivariate Logistic regression analysis showed that the patients' age and the volume of postpartum hemorrhage were independent risk factors for emergency peripartum hysterectomy caused by intractable postpartum hemorrhage (P<0.05).

Conclusion·The older the patients with intractable postpartum hemorrhage, the greater volume of postpartum hemorrhage, which is easy to lead to emergency peripartum hysterectomy. Clinical monitoring and intervention should be carried out as soon as possible to reduce the patients' incidence of emergency peripartum hysterectomy.

Key words: intractable postpartum hemorrhage, emergency peripartum hysterectomy, clinical characteristics

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