發(fā)布時間：2018-07-03 15:18

  本文選題：異位妊娠 + 危險因素��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：異位妊娠屬于急腹癥，在婦科中很常見。不僅女性的身體健康會因此遭受危害，而且以后的妊娠情況也可能為此產(chǎn)生不良影響。近些年來，異位妊娠在國內(nèi)外文獻中被廣泛報導(dǎo)�？梢园l(fā)現(xiàn)它的發(fā)生率有不斷上漲的趨勢。異位妊娠是孕產(chǎn)婦在受孕頭三個月中死亡的重要原因。而且人們的生活習慣和生活方式的改變在一定程度上也影響了異位妊娠的患病相關(guān)因素。我們發(fā)現(xiàn)，不同國家和地區(qū)的發(fā)病危險因素并不完全相同，這提示我們有些異位妊娠的危險因素是可以通過干預(yù)而加以改變的。為此，本文深入探究異位妊娠的危險因素，爭取為女性提供有效的一些預(yù)防辦法。從而達到使異位妊娠發(fā)生率下降的目的。 方法：本文回顧性分析了2009年1月至2013年11月大連醫(yī)科大學(xué)附屬第二醫(yī)院婦產(chǎn)科收治的確診為異位妊娠的住院患者427例，年齡18-45歲，，中位年齡為30歲，其中包括輸卵管妊娠406例，卵巢妊娠4例，宮頸妊娠8例，宮角部妊娠7例，剖宮產(chǎn)瘢痕部位妊娠2例。對所選病例采用病例對照研究，另隨機選取同一時間段住院的300例患者。這300例為正常妊娠婦女，年齡22-43歲，中位年齡為28歲，作為本次研究的對照組。統(tǒng)計數(shù)據(jù)均選用SPSS19.0軟件進行統(tǒng)計分析。對年齡等計量資料，選用均數(shù)和標準差來表示。對吸煙、月經(jīng)紊亂、子宮肌瘤、流產(chǎn)、盆腔炎性疾病、異位妊娠和下腹部手術(shù)歷史等計數(shù)資料采用卡方檢驗或連續(xù)性校正卡方檢驗進行統(tǒng)計學(xué)分析。P0.05時差異有統(tǒng)計學(xué)意義。采用非條件Logistic回歸分析中的后退逐步回歸法，分析有統(tǒng)計學(xué)意義的因素。了解它們與異位妊娠發(fā)生的相關(guān)性。 結(jié)果：1.異位妊娠發(fā)病的年齡主要集中在20-40歲。2.異位妊娠發(fā)病相關(guān)危險因素的單因素分析：流產(chǎn)史、盆腔炎性疾病史、下腹部手術(shù)史及異位妊娠史在異位妊娠患者和正常妊娠婦女之間的差異有統(tǒng)計學(xué)意義（P0.05），是異位妊娠發(fā)病的危險因素。吸煙史、子宮肌瘤和月經(jīng)紊亂史在異位妊娠患者和正常妊娠患者之間的差異無統(tǒng)計學(xué)意義（P0.05），不是異位妊娠發(fā)病的危險因素。3.異位妊娠發(fā)病相關(guān)危險因素的多因素分析：（1）盆腔炎性疾病史、異位妊娠史和下腹部手術(shù)史對異位妊娠的發(fā)病有明顯影響，是異位妊娠發(fā)病的獨立危險因素。（2）盆腔炎性疾病史、異位妊娠史和下腹部手術(shù)史均與異位妊娠的發(fā)病成正相關(guān)。（3）異位妊娠發(fā)病的獨立危險因素按風險從高到低依次為：盆腔炎性疾病史（OR=5.915）、異位妊娠史(OR=3.470)、下腹部手術(shù)史(OR=2.343)。 結(jié)論：1.異位妊娠的發(fā)病年齡主要集中在20-40歲，該階段的女性出現(xiàn)停經(jīng)史應(yīng)尤為注意。2.流產(chǎn)史、盆腔炎性疾病史、異位妊娠史和下腹部手術(shù)史是異位妊娠的危險因素，其中盆腔炎性疾病史、異位妊娠史和下腹部手術(shù)史是獨立危險因素。注意性生活衛(wèi)生，避免意外懷孕，減少流產(chǎn)次數(shù)，規(guī)范盆腔手術(shù)操作等可以減少異位妊娠發(fā)生的風險。
[Abstract]:Objective: ectopic pregnancy belongs to acute abdomen and is very common in gynecology. Not only are women's health jeopardized, but later pregnancies can also be adversely affected. In recent years, ectopic pregnancy has been widely reported in the literature at home and abroad. It can be found that the incidence of a rising trend. Ectopic pregnancy is an important cause of maternal death in the first three months of pregnancy. To some extent, the change of people's living habits and lifestyle also affects the related factors of ectopic pregnancy. We found that the risk factors for ectopic pregnancy were not the same in different countries and regions, suggesting that some of the risk factors of ectopic pregnancy could be changed by intervention. Therefore, this paper explores the risk factors of ectopic pregnancy and tries to provide some effective prevention methods for women. Thus, the incidence of ectopic pregnancy decreased. Methods: from January 2009 to November 2013, 427 patients with ectopic pregnancy, aged 18-45 years, with a median age of 30 years, were retrospectively analyzed in the Department of Gynecology and Obstetrics, second affiliated Hospital of Dalian Medical University. There were 406 cases of tubal pregnancy, 4 cases of ovarian pregnancy, 8 cases of cervical pregnancy, 7 cases of uterine corner pregnancy and 2 cases of cesarean scar pregnancy. A case-control study was conducted and 300 patients in the same time period were randomly selected. The 300 normal pregnant women, aged 22-43, with a median age of 28, served as controls. SPSS 19.0 software was used for statistical analysis. For age and other measurement data, use the mean and standard deviation to express. For smoking, menstrual disorders, uterine leiomyoma, abortion, pelvic inflammatory diseases, ectopic pregnancy and lower abdominal surgery history of counting data using chi-square test or continuity correction chi-square test statistical analysis. The regressive stepwise regression method in non-conditional logistic regression analysis was used to analyze the statistically significant factors. To understand their association with ectopic pregnancy. The result is 1: 1. The age of ectopic pregnancy is mainly 20-40 years old. Univariate analysis of risk factors associated with ectopic pregnancy: history of abortion, history of pelvic inflammatory disease, The history of lower abdominal surgery and ectopic pregnancy were significantly different between ectopic pregnancy and normal pregnant women (P0.05), which was the risk factor of ectopic pregnancy. Smoking history, hysteromyoma and menstrual disorder history between ectopic pregnancy patients and normal pregnancy patients had no statistical significance (P0.05), is not the risk factor of ectopic pregnancy. 3. Multivariate analysis of risk factors related to ectopic pregnancy: (1) history of pelvic inflammatory disease, history of ectopic pregnancy and history of lower abdominal surgery were independent risk factors of ectopic pregnancy. (2) history of pelvic inflammatory disease. The history of ectopic pregnancy and the history of lower abdominal surgery were positively correlated with the incidence of ectopic pregnancy. (3) the independent risk factors of ectopic pregnancy were: history of pelvic inflammatory disease (OR5.915), history of ectopic pregnancy (OR3.470), history of lower abdominal surgery (OR2.343). Conclusion 1. The onset age of ectopic pregnancy is mainly 20 to 40 years old. The history of menopause in women in this stage should be paid more attention to. 2. 2. History of abortion, history of pelvic inflammatory disease, history of ectopic pregnancy and history of lower abdominal surgery were risk factors of ectopic pregnancy, among which history of pelvic inflammatory disease, history of ectopic pregnancy and history of lower abdominal surgery were independent risk factors. Attention to sexual hygiene, avoid unwanted pregnancy, reduce the number of abortions, standardized pelvic surgery can reduce the risk of ectopic pregnancy.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.22

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