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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (04) : 309 -314. doi: 10.3877/cma.j.issn.2096-1537.2021.04.005

临床研究

某三甲医院产后出血单中心回顾性分析
陈明月1, 周霞庆1, 李沂玮1, 朱英1, 胡炜1,()   
  1. 1. 310000 浙江大学医学院附属杭州市第一人民医院重症医学科
  • 收稿日期:2021-09-29 出版日期:2021-11-28
  • 通信作者: 胡炜

A retrospective study of postpartum hemorrhage in a tertiary hospital

Mingyue Chen1, Xiaqing Zhou1, Yiwei Li1, Ying Zhu1, Wei Hu1,()   

  1. 1. Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
  • Received:2021-09-29 Published:2021-11-28
  • Corresponding author: Wei Hu
引用本文:

陈明月, 周霞庆, 李沂玮, 朱英, 胡炜. 某三甲医院产后出血单中心回顾性分析[J]. 中华重症医学电子杂志, 2021, 07(04): 309-314.

Mingyue Chen, Xiaqing Zhou, Yiwei Li, Ying Zhu, Wei Hu. A retrospective study of postpartum hemorrhage in a tertiary hospital[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(04): 309-314.

目的

分析产后出血(PPH)患者的分娩临床特点、合并症及出血原因等,以降低PPH发生率,提高孕产妇生存率。

方法

选择2014年10月1日至2021年7月31日杭州市第一人民医院收住的产妇共计35 257例,其中PPH患者2528例。根据是否入住ICU,将其分为危重组(45例)和普通组(2483例),采用回顾性分析方法,收集2组患者临床资料,分析其年龄、出血病因、妊娠并发症、妊娠合并症、出血干预手段、输血量、妊娠方式、母儿预后等特点。

结果

患者PPH发病率为7.2%(2528/35 257),PPH危重率为1.8%(45/2528)。PPH患者中,危重组较普通组年龄大[31.0(28.0,34.5)岁vs 29.0(27.0,32.0)岁,P=0.041]、住院时间长[9.0(6.0,12.0)d vs 4.0(4.0,6.0)d,P<0.001]、胎儿死亡发生率高(22.2% vs 1.8%,P<0.001)、不良妊娠或宫内操作史多(60.0% vs 8.1%,P<0.001)、接受有创止血方式多(包括宫腔填塞术、子宫动脉栓塞术、子宫切除术和开腹止血术)(51.1% vs 1.4%,P<0.001)、妊娠并发症高(93.4% vs 15.7%,P<0.001)、妊娠合并症高(39.9% vs 3.6%,P<0.001),差异均有统计学意义。未发生PPH产妇死亡。

结论

PPH是一种产科急症,当产妇年龄大、有不良妊娠或宫内操作史、存在妊娠期合并症或并发症时更容易发展为危重症,若能及时获得有效治疗,预后较好。

Objective

To analyze the clinical characteristics, complications and bleeding causes of postpartum hemorrhage (PPH) patients, so as to reduce the occurrence of PPH and improve the maternal survival rate.

Methods

A total of 2528 PPH patients admitted to the First People's Hospital of Hangzhou from October 1, 2014 to July 31, 2021 were enrolled. According to whether they were admitted to ICU, the patients were divided into critical group (45 cases) and general group (2483 cases), and clinical data were collected. A retrospective study was conducted to analyze the characteristics of PPH patients, such as age, bleeding etiology, pregnancy complications, pregnancy complications, bleeding intervention methods, blood transfusion volume, pregnancy mode, maternal and infant prognosis.

Results

The incidence of PPH was 7.2%(2528/35257), and the critical rate of PPH was 1.8%(45/2528). In PPH patients, the critical group was older [31.0 (28.0, 34.5) years vs 29.0 (27.0, 32.0) years, P=0.041], and hospital stay [9.0 (6.0, 12.0) days vs 4.0 (4.0, 6.0) days, P<0.001], and incidence of fetal loss (22.2% vs 1.8%, P<0.001), adverse pregnancy or intrauterine procedure (60.0% vs 8.1%, P<0.001), invasive hemostasis (including uterine packing, uterine artery embolization, hysterectomy, and open hemostasis) (51.1% vs 1.4%, P<0.001), pregnancy complications (93.4% vs 15.7%, P<0.001) and pregnancy comorbidity (39.9% vs 3.6%, P<0.001) were significantly higher in critical group compared to general group. No PPH maternal deaths occurred.

Conclusion

Postpartum hemorrhage is an obstetric emergency. Higher the maternal age, adverse pregnancy or intrauterine operation history, pregnancy complications or complications are more likely to develop into critical disease. If timely and effective treatment were carried out, the prognosis is better.

表1 2组患者基本临床特征比较
表2 2组患者的妊娠并发症及妊娠合并症比较[例(%)]
表3 2组患者出血病因分析[2528例,例(%)]
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