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目的讨论产科急症子宫切除术患者相关危险因素的分析,探讨子宫切除的时机和指征降低子宫切除率的可行方法。方法回顾性分析了2001年1月到2010年12月期间,某院收治的产科急症子宫切除的患者70例作为观察组,并且选择同期收治的68例剖宫产产后出血子宫未切除患者作为对照组。自行设计调查表,观察组和对照组分别从前置胎盘、胎盘早剥、子宫收缩乏力、子宫破裂、弥散性血管内凝血(DIC)、晚期产后出血、子宫肌瘤、疤痕子宫、宫腔感染、羊水过多、巨大儿等方面进行调查,分别采用单变量(χ2检验)进行对比,筛选出与子宫切除术有关因素。以及多变量(条件Logistic回归)方法筛选出主要危险因素。结果单因素分析显示病例组与对照组之间在前置胎盘(P﹤0.05)、胎盘早剥(P﹤0.05)、胎盘植入(P﹤0.05)、子宫破裂(P﹤0.05)、DIC(P﹤0.05)、出血量多(P﹤0.05)、子宫肌瘤(P﹤0.05)这7个方面差异有统计学意义;多因素条件Logistic回归显示只有前置胎盘(P﹤0.05)、胎盘早剥(P﹤0.05)、胎盘植入(P﹤0.05)、子宫破裂(P﹤0.05)、DIC(P﹤0.05)5个因素显示是危险因素,与子宫切除密切相关。结论子宫切除术与多种因素有关,加强对妇女患者的监测、提高警惕、减少子宫切除术的发生
Objective To discuss the risk factors of obstetric emergency hysterectomy and to explore the timing of hysterectomy and the feasible method of reducing the hysterectomy rate. Methods A retrospective analysis of 70 cases of obstetric emergency hysterectomy admitted to a hospital from January 2001 to December 2010 was taken as the observation group and 68 cases of cesarean section with uterine bleeding after cesarean section were selected as control group group. The questionnaire was designed by ourselves. The observation group and the control group were divided into three groups: placental abruption, placental abruption, uterine atony, uterine rupture, disseminated intravascular coagulation (DIC), postpartum hemorrhage, uterine fibroids, , Polyhydramnios, macrosomia and other aspects of the investigation, respectively, using univariate (χ2 test) for comparison, screening and hysterectomy related factors. And multivariate (conditional Logistic regression) method to screen out the main risk factors. Results Univariate analysis showed that placenta accreta (P <0.05), placental abruption (P <0.05), placenta accreta (P <0.05), uterine rupture (P < (P <0.05), more bleeding (P <0.05), and uterine fibroids (P <0.05). There were significant differences in seven aspects between the two groups (P <0.05) (P <0.05), placenta accreta (P <0.05), uterine rupture (P <0.05) and DIC (P <0.05) were risk factors, which were closely related to hysterectomy. Conclusions Hysterectomy is associated with a variety of factors that enhance the monitoring of women patients, increase vigilance and reduce the incidence of hysterectomy