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目的探讨产后出血量测定及出血量与血液指标的相关性。方法选择2012年3月-2015年3月在咸宁市第一人民医院妇产科进行足月阴道分娩的170例产妇作为研究对象,测定产妇从会阴切开至产后24 h的出血量。并根据出血量将产妇进行分组:A组108例(出血量<500 ml)、B组46例(出血量500~1 000 ml)、C组16例(出血量≥1 000 ml),检测并比较3组产妇产后24 h内的血液指标差异。结果产后24 h平均出血总量为(600.37±289.90)ml,其中产后2 h出血总量为(456.41±221.33)ml,占产后24 h出血总量的76.03%;第三产程出血量为(236.42±143.90)ml,占24 h出血总量的39.38%。产后A组的凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)均显著短于B组与C组(P<0.05),纤维蛋白原(FIB)、D-二聚体(D-D)、血红蛋白(HGB)、血小板(PLT)水平均显著高于B组与C组(P<0.05)。B组的PT、TT、APTT均显著短于C组(P<0.05),FIB、D-D、HGB、PLT水平均显著高于C组(P<0.05)。结论产后出血时间段主要集中在分娩后2 h内,该时间段出血量较大,应密切关注,同时密切监测产妇产后血液相关指标以了解产妇凝血功能的变化情况,对于降低产后大量出血的发生率及产妇死亡率具有积极意义。
Objective To investigate the relationship between postpartum hemorrhage volume and blood volume and blood index. Methods From March 2012 to March 2015, 170 cases of full-term vaginal delivery in the Department of Obstetrics and Gynecology, First People’s Hospital of Xianning City were selected as the study subjects and the amount of bleeding from the perineal incision to 24 hours after delivery was measured. According to the amount of bleeding, maternal groups were divided into group A (108 cases), group B (46 cases) (bleeding 500-1000 ml) and group C (16 cases) (bleeding ≥1 000 ml) The differences of blood indexes within 24 h postpartum among the three groups were compared. Results The average amount of hemorrhage at 24 h postpartum was (600.37 ± 289.90) ml, with the total amount of hemorrhage at 2 h postpartum being (456.41 ± 221.33) ml, accounting for 76.03% of the total hemorrhage at 24 h postpartum. The amount of bleeding in the third stage of labor was (236.42) ± 143.90) ml, accounting for 39.38% of the total 24 h bleeding. Prothrombin time (PT), thrombin time (TT) and APTT in postpartum group A were significantly shorter than those in group B and C (P <0.05), fibrinogen (FIB) D-dimer, hemoglobin and PLT were significantly higher than those in group B and group C (P <0.05). The PT, TT and APTT in group B were significantly shorter than those in group C (P <0.05). The levels of FIB, D-D, HGB and PLT in group B were significantly higher than those in group C (P <0.05). Conclusions The time period of postpartum hemorrhage mainly concentrates within 2 h after delivery. The hemorrhage amount should be closely monitored during this time period. At the same time, the postpartum blood related indexes should be closely monitored to understand the changes of coagulation function of maternal women, which can reduce the occurrence of massive postpartum hemorrhage Rate and maternal mortality have a positive meaning.