CAJ | 학술논문

目的为了降低HBV感染产妇的产后出血率和死亡率,探讨其产后出血的原因和影响因素.方法对上海市公共卫生临床中心2005年7月至2011年6月间的1021例HBV感染产妇分娩情况进行回顾性分析,计数资料比较采用x2检验.结果在1021例HBV感染产妇中,868例(85.01％)为无症状HBV携带者,其产后出血发生率为2.76％(24/868)；153例(14.99％)为慢性活动性乙型肝炎,其产后出血发生率为16.99％(26/153);两者比较,差异有统计学意义(x2=56.541,P＜0.01).产后出血的发生率为4.89％(50/1021),产后出血量＞1000 mL者17例,占34.00％.导致产后出血的原因中,子宫收缩乏力30例,占60.00％；胎盘因素11例,占22.00％;凝血功能障碍5例,占10.00％；软产道撕裂伤4例,占8.00％.产后出血的发生与分娩方式相关(x2=6.528,P=0.038),与流产次数(x2=16.269,P=0.000)、分娩次数(x2=6.990,P=0.008)、ALT水平(x2=56.541,P=0.000)及HBV DNA载量(x2=64.706,P=0.000)显著相关.结论 HBV感染产妇产后出血的原因主要有子宫收缩乏力、胎盘因素、软产道损伤及凝血功能障碍等,与流产次数、分娩次数、分娩方式、ALT水平及HBV DNA载量等因素有关.慢性活动性乙型肝炎患者比无症状HBV携带者更易发生产后出血.
목적 위료강저HBV감염산부적산후출혈솔화사망솔,탐토기산후출혈적원인화영향인소.방법 대상해시공공위생림상중심2005년7월지2011년6월간적1021례HBV감염산부분면정황진행회고성분석,계수자료비교채용x2검험.결과 재1021례HBV감염산부중,868례(85.01％)위무증상HBV휴대자,기산후출혈발생솔위2.76％(24/868)；153례(14.99％)위만성활동성을형간염,기산후출혈발생솔위16.99％(26/153);량자비교,차이유통계학의의(x2=56.541,P＜0.01).산후출혈적발생솔위4.89％(50/1021),산후출혈량＞1000 mL자17례,점34.00％.도치산후출혈적원인중,자궁수축핍력30례,점60.00％；태반인소11례,점22.00％;응혈공능장애5례,점10.00％；연산도시렬상4례,점8.00％.산후출혈적발생여분면방식상관(x2=6.528,P=0.038),여유산차수(x2=16.269,P=0.000)、분면차수(x2=6.990,P=0.008)、ALT수평(x2=56.541,P=0.000)급HBV DNA재량(x2=64.706,P=0.000)현저상관.결론 HBV감염산부산후출혈적원인주요유자궁수축핍력、태반인소、연산도손상급응혈공능장애등,여유산차수、분면차수、분면방식、ALT수평급HBV DNA재량등인소유관.만성활동성을형간염환자비무증상HBV휴대자경역발생산후출혈.
Objective To investigate the causes and risk factors of postpartum hemorrhage (PPH) in hepatitis B virus (HBV) infected parturient.Methods Retrospective analysis was performed on the 1021 HBV infected parturient from Shanghai Public Health Clinical Center from July 2005 to June 2011.The comparisons were done by chi-square test.Results Among 1021 cases of HBV infected parturient,868 (85.01％) were asymptomatic and the PPH rate was 2.76％ (24/868) ;the remaining 153 cases (14.99％) were chronic active hepatitis B and the PPH rate was 16.99％(26/153).The difference between two groups was statistically significant (x2 =56.541,P＜0.01).The total incidence rate of PPH was 4.89％ (50/1021) and 17 cases (34.00％) were postpartum hemorrhage＞1000mL.The causes of PPH included uterine inertia (30/50,60.00％),abnormal placenta (11/50,22.00％),dysfunction of coagulation (5/50,10.00％) and lesion of birth canal (4/50,8.00％).The risk factors of PPH included delivery mode (x2 =6.528,P=0.038),abortion times (x2 =16.269,P=0.000),delivery times (x2 =6.990,P=0.008),ALT levels (x2=56.541,P=0.000) and HBV DNA (x2 =64.706,P=0.000).Conclusions The main causes of PPH in HBV infected parturient include uterine inertia,abnormal placenta,lesion of birth canal and dysfunction of blood coagulation.PPH is correlated with abortion times,delivery times,delivery mode,liver function and HBV DNA.The incidence of PPH in parturient with chronic active hepatitis B is higher than asymptomatic parturient.