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目的探讨严重产后出血(postpartum hemorrhage,PPH)致子宫切除的原因和危险因素。方法将2004年10月至2014年10月在天门市第一人民医院妇产科因严重PPH行子宫切除术31例患者纳入观察组,同期62例PPH但未达到子宫切除指征产妇为对照组。分析两组产妇临床资料和难治性PPH致子宫切除的危险因素。结果 31例子宫切除原因为凝血功能障碍14例(45.2%),胎盘因素11例(35.5%),宫缩乏力5例(16.1%),贫血与血小板减少1例(3.2%),观察组中剖宫产与自然分娩原因构成有差异(P<0.05),观察组与对照组构成有差异(P<0.05)。Logistic回归分析显示剖宫产(OR=1.883,95%CI:1.177~1.980)、多胎妊娠(OR=2.587,95%CI:1.718~4.882)、巨大儿(OR=1.438,95%CI:1.280~2.736)是独立影响因素。结论严重PPH子宫切除常见病因为凝血功能障碍、胎盘因素和宫缩乏力;不同分娩方式出血原因构成不同;剖宫产、巨大儿和多胎妊娠是危险因素。
Objective To investigate the causes and risk factors of hysterectomy caused by severe postpartum hemorrhage (PPH). Methods From October 2004 to October 2014, 31 cases of obstetrics and gynecology in First People’s Hospital of Tianmen City due to severe PPH were included in the observation group, while 62 cases of PPH but did not reach the indication of hysterectomy as the control group . Analysis of two groups of maternal clinical data and refractory PPH-induced hysterectomy risk factors. Results 31 cases of hysterectomy were caused by coagulation disorders in 14 cases (45.2%), placenta in 11 cases (35.5%), uterine atresia in 5 cases (16.1%) and anemia and thrombocytopenia in 1 case (3.2% There were differences in causation between caesarean section and spontaneous labor (P <0.05). There was difference between the observation group and the control group (P <0.05). Logistic regression analysis showed that cesarean section (OR = 1.883, 95% CI: 1.177-1.980), multiple pregnancy (OR = 2.587, 95% CI: 1.718-4.882) 2.736) is an independent factor. Conclusions The common causes of severe hysterectomy of PPH are coagulopathy, placental factors and uterine atony. The causes of bleeding in different modes of delivery are different. Cesarean section, macrosomia and multiple pregnancy are risk factors.