摘要
目的探讨经阴道分娩产后出血(PPH)患者中严重产后出血(SPPH)的危险因素并建立预测模型。方法回顾分析山西省儿童医院产科2021年1月—2023年12月551例经阴道分娩产后出血的患者,按产后出血量将研究对象分为A组455例(轻度产后出血:产后出血量500~1000 mL)、B组96例(严重产后出血:产后出血量≥1000 mL),比较两组患者的相关因素,采用单因素分析、Lasso回归分析、Logistic多因素回归模型筛选产后出血的影响因素,建立产后出血风险预测列线图模型,并采用受试者工作特征(ROC)曲线图、校准曲线图、决策曲线分析(DCA)图及临床影响曲线(CIC)图评估预测模型的诊断效能。结果单因素分析显示,既往宫腔操作史、辅助生殖(试管婴儿)、妊娠期高血压、分娩镇痛、缩宫素催产、会阴侧切和胎盘残留对严重产后出血有影响(均P<0.05)。进一步利用Lasso回归分析筛选Logistic多因素回归分析变量,结果显示:6个危险因素纳入多因素Logistic回归分析,最终既往宫腔操作史、妊娠期高血压、分娩镇痛、缩宫素催产、会阴侧切和胎盘残留均为严重产后出血的独立危险因素(均P<0.05)。基于独立危险因素绘制严重产后出血风险预测列线图模型,其校准曲线与理想曲线较为接近,ROC曲线下面积(AUC)为0.741(95%CI:0.6871~0.7942),临床决策曲线及临床影响曲线显示阈值在0.05~0.5之间,模型具有较好的净获益,表明模型具有较好的应用价值。结论建立阴道分娩严重产后出血风险预测列线图模型可较好地预测阴道分娩严重产后出血发生风险,具有一定临床实用价值。
Objective To explore the risk factors for severe postpartum hemorrhage(SPPH)in patients with postpartum hemorrhage(PPH)after vaginal delivery and establish a predictive model.Methods A retrospective analysis was conducted on 551 parturients with postpartum hemorrhage who underwent vaginal delivery at the Obstetrics and Gynecology Department of Shanxi Children's Hospital from January 2021 to December 2023.The study subjects were divided into mild postpartum hemorrhage group A(postpartum hemorrhage volume of 500-1000 mL)and severe postpartum hemorrhage group B(postpartum hemorrhage volume≥1000 mL)based on the amount of postpartum hemorrhage.The causes and related factors of prenatal and postpartum hemorrhage in the two groups were compared,and univariate analysis and Lasso regression analysis were used.A Logistic multiple regression model was used to screen the influencing factors of postpartum hemorrhage,establish a line chart model for predicting postpartum hemorrhage risk,and evaluate the diagnostic efficacy of the prediction model using receiver operating characteristic(ROC)curve,calibration curve,decision curve analysis(DCA),and clinical impact curve(CIC).Results Univariate analysis showed that a history of previous intrauterine procedures,assisted reproduction(IVF),gestational hypertension,labor analgesia,oxytocin induced labor,perineal lateral resection,and placental residue had an impact on severe postpartum hemorrhage(P<0.05).Further use of Lasso regression analysis was used to screen for Logistic multivariate regression analysis variables.The results showed that six risk factors were included in the multivariate Logistic regression analysis.Ultimately,a history of uterine cavity surgery,gestational hypertension,labor analgesia,oxytocin induced labor,perineal lateral resection,and placental retention were all independent risk factors for severe postpartum hemorrhage(P<0.05).A column chart model for predicting the risk of severe postpartum hemorrhage was developed based on independent risk factors.The calibration curve of the model was close to the ideal curve,with an area under the ROC curve(AUC)of 0.741(95%CI:0.6871~0.7942).The clinical decision curve and clinical impact curve displayed thresholds between 0.05~0.5,indicating that the model had good net benefits and good application value.Conclusion The establishment of a column chart model for predicting the risk of severe postpartum hemorrhage during vaginal delivery can effectively predict the risk of such bleeding,and has certain clinical practical value.
作者
琚广鑫
陈韶慧
琚国胜
陈桂霞
JU Guangxin;CHEN Shaohui;JU Guosheng;CHEN Guixia(Shanxi Children's Hospital Affiliated to Shanxi Medical University,Taiyuan 030000,China;The Sixth Affiliated Hospital of Shanxi Medical University,Taiyuan 030008,China)
出处
《西部医学》
2025年第9期1374-1379,共6页
Medical Journal of West China
基金
山西省科技厅自然科学基金项目(202203021211063)。
关键词
严重产后出血
阴道分娩
危险因素
风险预测
临床实用价值
Severe postpartum hemorrhage
Vaginal delivery
Risk factors
Risk profile
Clinical practical value
