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目的 准确估计产后出血量 ,了解产后出血量与生命体征、血红蛋白及红细胞压积间的关系。方法 应用客观测定法 (称重法、容积法、羊水压积测定法 )和主观测定法 (目测法 )测量自然分娩和剖宫产妇女的产后出血量 ,同时测定产前、产时和产后血压、心率、血红蛋白和红细胞压积。结果 ①自然分娩组产妇平均出血量为( 3 62 2 5± 186 91)mL ,95 %可信性为 710 0 1mL。剖宫产组平均出血量为 ( 5 2 7 77± 3 0 4 15 )mL ,95 %可信性为10 3 4 4 2mL。②目测法测量自然分娩组平均产后出血量 ( 176 4 4± 5 7 71)mL ,仅为客观测量法的 4 8 71% ,剖宫产组平均产后出血量 ( 2 5 4 0 4± 115 61)mL ,仅为客观测量法的 4 8 13 %。③临产前、临产后、第二产程、第三产程、产后 3 0、60和 12 0min两组产妇血压、心率、血红蛋白和红细胞压积均无明显差异。结论 阴道分娩和剖宫产分娩的产后出血量可以区别定义。目前临床目测法估计产后出血量较实际出血量减少 5 0 %。机体充足的代偿功能使产妇出血量在 10 0 0mL内生命体征稳定 ,血红蛋白和红细胞压积无明显改变。
Objective To accurately estimate the amount of postpartum hemorrhage and to understand the relationship between postpartum hemorrhage and vital signs, hemoglobin and hematocrit. Methods The objective measures (weighing method, volumetric method, amniotic fluid pressure measurement method) and subjective determination method (visual method) were used to measure the amount of postpartum hemorrhage in spontaneous delivery and cesarean section women. Meanwhile, the prenatal, Blood pressure, heart rate, hemoglobin and hematocrit. Results ① In the spontaneous labor group, the average amount of bleeding was (3 62 2 ± 5 ± 186 91) mL and 95% confidence was 710 0 1 mL. The average amount of bleeding in the cesarean section group was (527 77 ± 3 0 4 15) mL, with a 95% confidence level of 103 34 2 mL. ② The average postpartum hemorrhage volume in the spontaneous labor group was 176 4 4 ± 5 7 71 mL measured by visual inspection, which was only 48 58% of the objective measurement. The average postpartum hemorrhage in the cesarean section group was 25 44 ± 115 61 ) mL, only 4 8 13% of the objective measurement. Pre-labor, after labor, the second stage of labor, the third stage of labor, postpartum 30,60 and 120min two groups of maternal blood pressure, heart rate, hemoglobin and hematocrit no significant difference. Conclusions Vaginal delivery and cesarean delivery for postpartum hemorrhage can be defined differently. The current clinical visual assessment of postpartum hemorrhage was 50% less than the actual amount of bleeding. Adequate body compensatory function of the maternal bleeding in 10 0mL within the stability of vital signs, hemoglobin and hematocrit no significant change.