摘要
目的探索失血性休克产妇的临床特点,比较联合急救方案与传统急救方案的临床效果。方法回顾性分析2018年1月到2025年1月中国人民解放军联勤保障部队第九七○医院威海医疗区妇产科救治的82例失血性休克患者的临床资料。根据急救方案,分为观察组(联合急救方案,41例)和对照组(传统急救方案,41例)。记录分析所有患者的临床症状和体征、导致出血性休克的原因,以及休克程度的分布,并比较两组患者休克纠正时间、住院总时间、并发症的发生情况、子宫切除率、死亡率。对影响休克纠正时间的相关因素进行多元线性回归分析。结果82例产科失血性休克患者的休克程度以中度为主(38例,占比46.34%)。观察组患者休克纠正时间(P<0.001)和住院时间(P<0.001)均显著短于对照组。多元线性回归分析结果显示,观察组的休克纠正时间显著短于对照组(P=0.016)。中度休克较轻度休克纠正时间延长(β=0.537,P=0.046),重度休克的纠正时间更长(β=1.103,P=0.019);阴道分娩患者的休克纠正时间较剖宫产显著延长(β=0.892,P=0.009);宫缩乏力与更短的休克纠正时间相关(β=-0.318,P=0.011);胎盘因素则显著延长纠正时间(β=0.211,P=0.029)。观察组患者并发症的发生率为17.07%,显著低于对照组的36.59%(P<0.05)。两组患者的子宫切除率(9.76%vs.14.63%)和死亡率(0.00%vs.2.44%)相比,差异均无统计学意义(P>0.05)。结论联合急救方案显著优于传统急救方案,可显著缩短休克纠正时间和住院时间,且并发症发生率较低。多元线性回归分析表明,中度和重度休克、阴道分娩、宫缩乏力及胎盘因素均对休克纠正时间有显著影响。早期识别高危因素及多学科协作是提高救治成功率的关键。
Objective To explore the clinical characteristics of obstetric hemorrhagic shock and compare the clinical outcomes of combined resuscitation protocols with traditional resuscitation protocols.Methods A retrospective analysis was conducted on the clinical data of 82 obstetric hemorrhagic shock patients treated in the Department of Obstetrics and Gynecology at the 970th Hospital of the Joint Logistics Support Force,Weihai Medical Area,from January 2018 to January 2025.Based on the resuscitation protocol,patients were divided into the observation group(combined resuscitation protocol,41 patients)and the control group(traditional resuscitation protocol,41 patients).Clinical symptoms and signs,causes of hemorrhagic shock,and shock severity distribution were recorded.The shock correction time,total hospital stay,incidence of complications,rate of hysterectomy,and mortality were compared between the two groups.Multivariate linear regression analysis was performed to identify factors affecting shock correction time.Results Among the 82 obstetric hemorrhagic shock patients,the majority(46.34%)had moderate shock(38 cases).The shock correction time(P<0.001)and hospital stay(P<0.001)were significantly shorter in the observation group compared to the control group.Multivariate linear regression analysis showed that the shock correction time in the observation group was significantly shorter than in the control group(P=0.016).The correction time for moderate shock was longer than for mild shock(β=0.537,P=0.046),and the correction time for severe shock was even longer(β=1.103,P=0.019).Vaginal delivery was associated with a significantly longer shock correction time compared to cesarean section(β=0.892,P=0.009).Uterine atony was associated with a shorter shock correction time(β=-0.318,P=0.011),while placental factors significantly prolonged the correction time(β=0.211,P=0.029).The incidence of complications in the observation group was 17.07%,significantly lower than 36.59%in the control group(P<0.05).No statistically significant differences were observed between the two groups in terms of hysterectomy rate(9.76%vs.14.63%,P>0.05)and mortality rate(0.00%vs.2.44%,P>0.05).Conclusion The combined resuscitation protocol is significantly superior to the traditional protocol,effectively shortening the shock correction time and hospital stay,with a lower incidence of complications.Multivariate linear regression analysis indicates that moderate and severe shock,vaginal delivery,uterine atony,and placental factors significantly influence shock correction time.Early identification of high-risk factors and multidisciplinary collaboration are key to improving the success rate of treatment.
作者
遇红
高会广
裴丽鹏
刘丽娜
YU Hong;GAO Huiguang;PEI lipeng;lIU lina(Department of Obstetrics and Gynecology,970th Hospital of the Joint Logistics Support Force,Weihai Medical Area,Weihai,Shandong 264200,China;Hospital Office,970th Hospital of the Joint Logistics Support Force,Weihai Medical Area,Weihai,Shandong 264200,China;Department of Gynecology,Northern Theater Command General Hospital,Shenyang 110015,China)
出处
《中华灾害救援医学》
2025年第6期719-723,共5页
Chinese Journal of Disaster Medicine
基金
2023年辽宁省科技计划联合计划(基金)项目(2023020959-JH2/1017)。
关键词
产科失血性休克
联合急救方案
休克纠正时间
Obstetric hemorrhagic shock
Combined resuscitation protocol
Shock correction time
