王永梅 汪剑 孟荔 史爱武

[摘要] 目的 分析產后出血伴发凝血功能障碍的一般情况及相关危险因素，提高临床医生对产后出血高危因素的认识和救治。 方法 回顾性分析我院2016年1月～2018年12月产科MICU收治的产后出血伴发凝血功能障碍的产妇58例作为观察组，按照出血量多少（<30%，30%～50%，51%～70%，>70%）分成四组，比较各组在活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（Fib）、血红蛋白（HB）、血小板（Plt）水平差异;同时选择同期产后出血没有伴发凝血功能障碍的产妇59例作为对照组，对产后出血相关危险因素行Logistic回归分析。 结果 在观察组中四组凝血指标比较无明显统计学差异;在产后出血高危因素中，瘢痕子宫、前置胎盘、胎盘植入在观察组与对照组两组之间比较差异有统计学意义（P<0.05），Logistic回归分析显示瘢痕子宫、胎盘植入与产后出血伴发凝血功能障碍明显相关（OR=4.249，95%CI=1.506～11.984，P=0.006;OR=5.880，95%CI=1.551～22.296，P=0.009）。结论 瘢痕子宫、胎盘植入与产后出血早期凝血功能障碍明显相关，是产后出血早期出现凝血功能障碍的高危因素。

[关键词] 产后出血;凝血功能障碍;瘢痕子宫;胎盘植入

[中图分类号] R714          [文献标识码] B          [文章编号] 1673-9701（2020）18-0082-03

Analysis of risk factors related to postpartum hemorrhage combined with coagulation dysfunction

WANG Yongmei   WANG Jian   MENG Li   SHI Aiwu

Medical Intensive Care Unit， Nanjing Medical University Obstetrics and Gynecology Hospital， Nanjing Maternal and Child Health Hospital， Nanjing   210004， China

[Abstract] Objective To analyze the general situation and related risk factors of postpartum hemorrhage accompanied by coagulation dysfunction， and to improve clinicians' understanding of high risk factors and treatment for postpartum hemorrhage. Methods Fifty-eight cases of postpartum hemorrhage combined with coagulation dysfunction from January 2016 to December 2018 were selected as the observation group， and were divided into four groups according to the amount of bleeding （<30%， 30%-50%， 51%-70%， >70%）.The levels of activated partial thromboplastin time （APTT）， prothrombin time （PT）， fibrinogen （Fib）， hemoglobin （HB）， and platelet （Plt） between groups were compared. At the same time， 59 women with postpartum hemorrhage who had no coagulation dysfunction during the same period were selected as the control group.Logistic regression analysis was performed on risk factors related to postpartum hemorrhage. Results In the observation group， there was no significant statistical difference between the four groups of coagulation indicators. Among the high risk factors for postpartum hemorrhage， there were statistically significant differences in scar uterus， placenta previa， and placenta accreta between the observation group and the control group（P<0.05）. Logistic regression analysis showed that scar uterus and placenta accreta were significantly associated with postpartum hemorrhage accompanied by coagulation dysfunction（OR=4.249， 95%CI=1.506-11.984， P=0.006; OR=5.880， 95%CI=1.551-22.296， P=0.009）. Conclusion Scar uterus and placenta accreta are significantly related to coagulation dysfunction in early postpartum hemorrhage， and are high-risk factors for coagulation dysfunction in early postpartum hemorrhage.

[Key words] Postpartum hemorrhage; Coagulation dysfunction; Scarred uterus; Placenta implantation

产后出血是产科分娩的严重并发症，是孕产妇死亡的首要原因[1，2]，而严重产后出血所致继发性凝血功能障碍常常使出血更难以控制，据统计，由于产后严重出血所致的凝血功能障碍发病率在0.15%～0.5%[3]。本文选取117例产后出血产妇，按凝血指标有无异常分为观察组（n=58，产后出血伴发凝血功能障碍）与对照组（n=59，产后出血无凝血功能障碍），通过对两组产妇的相关分析探讨产后出血伴发凝血功能障碍的相关危险因素，提高临床医生对产后出血危险因素的重视，现报道如下。

1 资料与方法

1.1 一般资料

选择2016年1月～2018年12月南京市妇幼保健院产科ICU收治的符合产后出血诊断的产妇共117例。……