摘要
目的 为了探讨产后出血的主要高危因素,为制订防治措施提供参考。方法 以产后2小时内总失血量≥400ml或24小时内失血量≥500ml的1 976例产妇作为病例组;以当地同期的顺产产妇作为对照组,进行1:2配比病例对照研究,通过条件Logistic回归分析筛选出主要的危险因素,然后通过因子分折,提出防治策略。结果 单因素分析中28个因素有统计学意义,其中9个因素进入多因素回归模型:人流史(OR=5.53)、产前检查<2次(OR=6.27)、妊高征(OR=4.01)、胎位异常(OR=3.67)、第二产程延长(OR=3.33)、剖宫产(OR=4.02)、宫缩乏力(OR=7.94)、产道损伤(OR=2.88)、焦虑心理(OR=7.16)。因子分析表明,产后出血的主要危险因素可归结为4个方面:子宫收缩机能、助产技术、孕期保健服务和心理因素。结论 做好生殖健康教育、孕期保健和心理指导工作有利于产后出血预防,而加强接产人员基本助产技术的培训是防治产后出血的关键。
OBJECTIVE To identify the risk factors associated with postpartum hemorrhage (PPH) in order to improve the effectiveness of intervention on PPH. METHODS A 1:2 matched population - based case - control study was undertaken on two groups of women,one group consisting of 1 976 cases with PPH (blood loss equal to or more than 400ml in 2 hrs or 500ml in 24 hrs) and the order of women with normal unassisted vaginal delivery without PPH. Data including 70 items abstracted from the medical care records. Odd Ratios were estimated by univariable and multivariate conditional logistic regression and common factors were extracted by exploratory factor analysis. RESULTS Twenty-eight factors were associated with PPH significantly and nine of them entered the last regression model, i. e. abortion history (OR = 5.53), frequency of examination ante partum < 2 (OR = 6.27), pregnancy induced hypertension (OR = 4.01), malposition (OR = 3.67), prolonged second stage of labor (OR = 3.33), abdominal delivery (OR = 4.02), uterine hypodynamic contraction (OR = 7.94), birth canal injury (OR = 2.88), dysphoric psy-chology(OR= 7.16) .The identified risk factors were statistically extracted four common factors, which including uterine contractility, obstetric technique, health care during pregnancy and psychology. CONCLUSIONS These findings confirm that it s very important for PPH prevention to emphasize reproductive health education, physiologic and mental care during pregnancy, and enhancing the training for obstetric basic skill is the key to PPH prevention.
出处
《中国初级卫生保健》
2003年第3期54-56,共3页
Chinese Primary Health Care
基金
韶关市重点科技计划项目(韶科[卫]2001-27)
关键词
产后出血
危险因素
病例对照
因子分析
postpartum hemorrhage, risk factors, case - control, factor analysis
