本文選題：產(chǎn)后出血 + 危險(xiǎn)因素　； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 分析產(chǎn)后出血(postpartum hemorrhage，PPH)發(fā)生的危險(xiǎn)因素，建立嚴(yán)重產(chǎn)后出血預(yù)測(cè)評(píng)分表，，為闡明產(chǎn)后出血病因以及評(píng)估嚴(yán)重產(chǎn)后出血發(fā)生風(fēng)險(xiǎn)提供依據(jù)。 方法 采用大樣本回顧性分析的流行病學(xué)方法，選取2009年01月-2012年12月期間于北京軍區(qū)總醫(yī)院婦產(chǎn)科住院分娩救治的產(chǎn)后出血患者351人作為觀察對(duì)象，另選取同期分娩未發(fā)生產(chǎn)后出血的孕婦351人作為對(duì)照。采集兩組孕婦的相關(guān)參數(shù)：1、人口學(xué)特征：產(chǎn)婦的年齡、分娩時(shí)孕齡、孕次、產(chǎn)次、新生兒出生體重等；2、妊娠相關(guān)特征性參數(shù)：分娩方式、產(chǎn)后出血量、胎盤粘連、前置胎盤、胎盤胎膜殘留、妊娠期高血壓疾病、產(chǎn)程圖、胎數(shù)等。采用獨(dú)立樣本t檢驗(yàn)、x2檢驗(yàn)、秩和檢驗(yàn)以及l(fā)ogistic回歸分析等統(tǒng)計(jì)學(xué)方法研究產(chǎn)后出血和嚴(yán)重產(chǎn)后出血發(fā)生的相關(guān)危險(xiǎn)因素；根據(jù)統(tǒng)計(jì)結(jié)果找出產(chǎn)后出血和嚴(yán)重產(chǎn)后出血的高危因素，對(duì)其進(jìn)行量化評(píng)分，建立預(yù)測(cè)評(píng)分表；采用logistic回歸建立產(chǎn)后出血和嚴(yán)重產(chǎn)后出血風(fēng)險(xiǎn)預(yù)測(cè)回歸方程。 結(jié)果 1.產(chǎn)后出血發(fā)生的相關(guān)危險(xiǎn)因素分析：（1）單因素分析顯示：觀察組孕婦所生新生兒出生體重較對(duì)照組顯著升高（P＜0.05）；觀察組孕婦孕周37周、剖宮產(chǎn)分娩、胎盤粘連、巨大胎兒、胎盤植入、前置胎盤、妊娠期高血壓疾病、多胎妊娠的發(fā)生率較對(duì)照組顯著升高（P＜0.05）；（2）多因素回歸分析顯示：孕周分組、分娩方式、胎盤粘連、新生兒體重、前置胎盤5個(gè)因素進(jìn)入回歸模型；按OR值大小順次為胎盤粘連、前置胎盤、孕周分組、分組方式、新生兒體重。 2.嚴(yán)重產(chǎn)后出血發(fā)生的相關(guān)危險(xiǎn)因素分析：（1）單因素分析顯示：嚴(yán)重產(chǎn)后出血孕婦中年齡≥35歲、前置胎盤、胎盤植入的發(fā)生率均較輕度產(chǎn)后出血孕婦顯著升高，兩組間分娩方式構(gòu)成比例不同（P＜0.05）。（2）多因素回歸分析顯示：年齡分組、分娩方式、胎盤植入3個(gè)因素進(jìn)入回歸模型；按OR值大小順次為胎盤植入、年齡分組和分娩方式。 3.產(chǎn)后出血風(fēng)險(xiǎn)預(yù)測(cè)：根據(jù)自制的嚴(yán)重產(chǎn)后出血預(yù)測(cè)評(píng)分表，經(jīng)Logistic回歸分析，得出產(chǎn)后出血風(fēng)險(xiǎn)預(yù)測(cè)回歸方程為P=exp（-0.858＋0.443*產(chǎn)后出血預(yù)測(cè)評(píng)分）/（1＋exp（-0.858＋0.443*產(chǎn)后出血預(yù)測(cè)評(píng)分））；當(dāng)產(chǎn)后出血預(yù)測(cè)評(píng)分為6分時(shí)產(chǎn)后出血的可能的發(fā)生率為48.51%；同樣根據(jù)嚴(yán)重產(chǎn)后出血預(yù)測(cè)評(píng)分表，經(jīng)Logistic回歸分析，得出嚴(yán)重產(chǎn)后出血風(fēng)險(xiǎn)預(yù)測(cè)回歸方程為P=exp（-3.068＋0.155*產(chǎn)后出血預(yù)測(cè)評(píng)分+0.380*嚴(yán)重產(chǎn)后出血預(yù)測(cè)評(píng)分）/（1＋exp（-3.068＋0.155*產(chǎn)后出血預(yù)測(cè)評(píng)分+0.380*嚴(yán)重產(chǎn)后出血預(yù)測(cè)評(píng)分））；當(dāng)產(chǎn)后出血預(yù)測(cè)評(píng)分為6分且嚴(yán)重產(chǎn)后出血預(yù)測(cè)評(píng)分為5分時(shí)嚴(yán)重產(chǎn)后出血的可能的發(fā)生率為44.07%；產(chǎn)后出血預(yù)測(cè)評(píng)分與產(chǎn)后出血發(fā)病率呈正相關(guān)（r=0.353，P=0.00）。 結(jié)論 1.胎盤粘連、前置胎盤、孕周分組、巨大胎兒、分娩方式、胎盤植入、妊娠期高血壓疾病和胎數(shù)是引起產(chǎn)后出血的危險(xiǎn)因素，其中胎盤粘連、前置胎盤、孕周分組、分娩方式和新生兒體重是產(chǎn)后出血的獨(dú)立危險(xiǎn)因素。 2.年齡、分娩方式、胎盤植入、前置胎盤是引起嚴(yán)重產(chǎn)后出血的危險(xiǎn)因素，其中年齡、分娩方式、胎盤植入是嚴(yán)重產(chǎn)后出血的獨(dú)立危險(xiǎn)因素。 3.預(yù)測(cè)評(píng)分表對(duì)于篩查可能發(fā)生產(chǎn)后出血及嚴(yán)重產(chǎn)后出血的病例具有臨床應(yīng)用意義，對(duì)評(píng)分高的孕產(chǎn)婦進(jìn)行及早的干預(yù)治療，可能對(duì)降低產(chǎn)后出血的發(fā)生具有積極影響。
[Abstract]:objective
To analyze the risk factors of postpartum hemorrhage (postpartum hemorrhage, PPH) and establish a serious postpartum hemorrhage prediction score table, which provides the basis for clarifying the cause of postpartum hemorrhage and assessing the risk of severe postpartum hemorrhage.
Method
The epidemiological methods of large sample retrospective analysis were used to select 351 postpartum haemorrhage patients in the Department of Obstetrics and Gynecology of General Hospital of Beijing Military Region during the period of 01 months of 2009 -2012 year and December. 351 of the pregnant women who had not produced postpartum hemorrhage in the same period were selected as the control. The related parameters of two groups of pregnant women were collected: 1, people. Oral characteristics: maternal age, birth time, pregnancy, birth, birth weight, birth weight, etc.; 2, pregnancy related characteristic parameters: delivery mode, postpartum hemorrhage, placental adhesion, placenta previa, placenta and fetal membrane residue, pregnancy induced hypertension, labor history, fetal number and so on. Independent sample t test, X2 test, rank sum test and logisti C regression analysis and other statistical methods were used to study the risk factors associated with postpartum hemorrhage and severe postpartum hemorrhage. According to the statistical results, the risk factors of postpartum hemorrhage and severe postpartum hemorrhage were found, the quantitative scores were evaluated, the prediction score was set up, and the risk of postpartum hemorrhage and severe postpartum hemorrhage was established by logistic regression. Equation.
Result
1. analysis of related risk factors of postpartum hemorrhage: (1) single factor analysis showed that the birth weight of pregnant women in the observation group was significantly higher than that of the control group (P < 0.05); the pregnant women in the observation group were pregnant 37 weeks, Caesarean birth, placental adhesion, fetal macrosomia, placenta implantation, placenta previa, pregnancy induced hypertension and multiple pregnancy. The rate was significantly higher than that in the control group (P < 0.05); (2) multiple regression analysis showed that 5 factors of pregnancy week, delivery mode, placental adhesion, newborn weight, and placenta previa entered the regression model, and placental adhesion, placenta previa, gestational week group, grouping mode, newborn weight according to the OR value.
2. analysis of the related risk factors of severe postpartum hemorrhage: (1) single factor analysis showed that the age of pregnant women with severe postpartum hemorrhage was more than 35 years old, placenta previa, placental implantation rate was significantly higher than that of pregnant women with mild postpartum hemorrhage, and the proportion of delivery modes in the two groups was different (P < 0.05). (2) multiple regression analysis showed that age points were: Group, delivery mode, placenta implantation 3 factors into the regression model; according to OR value, placenta implantation, age grouping and delivery mode.
3. risk prediction of postpartum hemorrhage: according to the self-made severe postpartum hemorrhage prediction score, after Logistic regression analysis, the regression equation of postpartum hemorrhage risk was calculated to be P=exp (- 0. 8. 8 +. 4, 4, 4, postpartum hemorrhage prediction score) / (1 + ex P (- 0. 8. 8 +. 4. 4. 4) postpartum hemorrhage). The possible incidence was 48.51%; also based on the severe postpartum hemorrhage prediction score, the Logistic regression analysis showed that the regression equation for the risk of severe postpartum hemorrhage was P=exp (- 3. 0. 0. 6 +. 15 5 * postpartum hemorrhage prediction score of +0.380* severe postpartum hemorrhage) / (1 + ex (- 3. 0. 6 +. 15 5 *) postpartum hemorrhage prediction score of +0.380* serious birth The incidence of severe postpartum hemorrhage was 44.07% when the postpartum hemorrhage prediction score was 6 and the severe postpartum hemorrhage prediction score was 5, and the postpartum hemorrhage prediction score was positively correlated with the incidence of postpartum hemorrhage (r=0.353, P=0.00).
conclusion
1. Placenta Adhesion, placenta previa, grouping of gestational weeks, fetal macrosomia, delivery mode, placenta implantation, pregnancy induced hypertension and fetal number are risk factors for postpartum hemorrhage. Placental adhesion, placenta previa, gestational weeks, delivery mode and newborn weight are independent risk factors for postpartum hemorrhage.
The 2. age, mode of delivery, placenta implantation, and placenta previa are risk factors for severe postpartum hemorrhage, of which age, mode of delivery, and placental implantation are independent risk factors for severe postpartum hemorrhage.
The 3. prediction score table is of clinical significance for the screening of cases of postpartum hemorrhage and severe postpartum hemorrhage. The early intervention treatment for high grade pregnant and parturient may have a positive effect on reducing the occurrence of postpartum hemorrhage.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.461

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