223例产后出血原因研究.doc

223例产后出血原因研究[摘要] 目的：探讨引起产后出血的临床原因。方法：回顾性分析本院223例产后出血患者的临床资料，分析其产后出血发生的原因及处理措施，进一步探讨防治产后出血的有效方案。结果：本院5年内平均产后出血发生率为1.5%。其中宫缩乏力占65.92%，软产道损伤占20.63%，胎盘因素占12.56%，凝血功能异常占0.90%，阴道分娩与剖宫产后产后出血率比较差异无统计学意义。结论：引起产后出血的主要原因是宫缩乏力，胎盘因素（胎盘粘连、胎盘植入）及软产道损伤，阴道分娩与剖宫产产后出血发生率无明显差别。 [关键词] 产后出血；宫缩乏力；胎盘粘连植入；软产道损伤 [中图分类号] R714.46+1 [文献标识码]C [文章编号]1674-4721（2011）08（a）-169-02 The analysis on the cause of 223 cases of postpartum hemorrhage WANG Jian, SHANGGUAN Linli Department of Gynaecology and Obstetrics, Sijing People′s Hospital of Songjiang, Shanghai 201601, China [Abstract] Objective: To study the cause of postpartum hemorrhage. Methods: The clinical data of 223 cases with postpartum hemorrhage in our hospital were retrospectively analyzed, the treatment measures and cause of postpartum hemorrhage were analyzed, and the effective method of prevention and treatment was further studied. Results: The average 5-year rate of postpartum hemorrhage in our hospital was 1.5%, the rate of uterine inertia was 65.92%, the rate of soft birth canal injury was 20.18%, the rate of placenta was 13.00%, the rate of coagulopathy was 0.9%, there were no significant differences between the rates of vaginal delivery and cesarean section. Conclusion: The main factors of causing the postpartum hemorrhage are uterine inertia, placenta(placenta accrete, placenta implantation) and soft birth canal injury, the postpartum hemorrhage rate of vaginal delivery and cesarean section has no significant differences. [Key words] Postpartum hemorrhage; Uterine inertia; Placenta accrete andimplantation; Soft birth canal injury 胎儿娩出后24 h内阴道出血量≥500 ml称产后出血。目前产后出血仍是导致孕产妇死亡的首位原因，是产科严重并发症。2006年1月1日～2010年12月31日本院共分娩14 493例产妇，采用回顾性研究的方法，对14 493例孕产妇的临床资料进行分析，探讨引起产后出血的原因及处理方法，分析阴道分娩与剖宫产引起产后出血有无差别，从而为降低产后出血提供临床依据。 1 资料与方法 1.1 一般资料 选择2006年1月1日～2010年12月31日，在本院分娩的孕产妇中产后出血223例，同期分娩数为14 493例。 1.2 方法 失血量的计算方法：阴道分娩者采用面积法，浸湿两层敷料的面积来估算，如5 cm×5 cm计血量为2 ml；10 cm×10 cm计血量为5 ml；15 cm×15 cm计血量为10 ml；剖宫产者出血量计算方式为：术中