难治性产后出血子宫切除术的病因及危险因素分析

Analysis of Etiology and Risk Factors of Hysterectomy for Refractory Postpartum Hemorrhage

摘要: 目的：难治性产后出血子宫切除术的病因及危险因素分析。方法：通过我院个案数据库收集我院2012年1月至2020年12月所有顺利分娩患者的病历资料，筛选出难治性产后出血病例共336例，其中57例实施子宫切除术病例为观察组，279例未实施子宫切除术病例为对照组；对两组的病因及危险因素采用c2检验、多因素Logistic回归分析等方法进行统计学分析；同时对9年间病因及危险因素的发生趋势进行趋势c2检验。结果：1) 2012~2020年因难治性产后出血行急症子宫切除的患者共57例，子宫切除率为 16.96% (57/336)；2) 胎盘因素为实施紧急子宫切除术的主要原因，包括胎盘植入、前置胎盘等；3) 经单因素分析证实，产妇年龄、分娩方式、孕产次、血色素、多次宫腔操作史等差异均有统计学意义(P < 0.05)；多因素Logistic回归分析显示，既往剖宫产史、孕次、血色素是难治性产后出血子宫切除术的独立危险因素(P < 0.05)；4) 近9年既往剖宫产史、分娩方式为剖宫产、子宫破裂、宫缩乏力发病率整体呈上升趋势。且其发病率随年龄增长亦呈上升趋势。结论：难治性产后出血子宫切除的主要原因为胎盘因素，其次为凝血功能障碍、子宫收缩乏力等，合并既往剖宫产史、贫血等高危因素的患者实施子宫切除术的风险更高。

Abstract: Objective: To analyze the etiology and risk factors of hysterectomy for refractory postpartum hemorrhage. Methods: The medical records of all patients with successful delivery in our hospital from January 2012 to December 2020 were collected through the case database of our hospital. A total of 336 cases of intractable postpartum hemorrhage were selected, including 57 cases of hysterectomy as the observation group and 279 cases of non-hysterectomy as the control group. The etiology and risk factors of the two groups were statistically analyzed by 2-test and multivariate logistic regression analysis. At the same time, the occurrence trend of etiology and risk factors in 9 years was tested by trend 2 test. Results: 1) From 2012 to 2020, 57 patients underwent emergency hysterectomy due to intractable postpartum hemorrhage, and the hysterectomy rate was 16.96% (57/336); 2) Placental factors are the main causes of emergency hysterectomy, including placenta implantation, placenta previa and so on; 3) Univariate analysis showed that there were significant differences in maternal age, mode of delivery, times of pregnancy and childbirth, hemoglobin and multiple uterine cavity operation history (P < 0.05). Logistic regression analysis showed that the risk factors of cesarean section and postpartum hemorrhage were multiple pregnancy and postpartum hemorrhage (P < 0.05); 4) The past 9 years of previous cesarean section history, the mode of delivery for cesarean section, uterine rupture, uterine atony incidence rate overall showed an upward trend. The incidence rate also increases with age. Conclusion: The main cause of hysterectomy for intractable postpartum hemorrhage is placental factors, followed by coagulation dysfunction and uterine atony. Patients with high-risk factors such as previous cesarean section and anemia have a higher risk of hysterectomy.