背景:尚未建立针对产后出血(PPH)的标准治疗指南。我们旨在评估接受手术和非手术治疗的PPH患者在预后和预后方面的差异。
方法:这项回顾性研究包括2013年8月至2023年10月在两家转诊医院诊断为PPH的230例患者。将患者分为非手术组(第1组,n=159)和手术干预组(第2组,n=71)。通过将手术干预组分为立即(n=45)和延迟手术干预组(n=26)进行亚组分析。
结果:第2组的初始乳酸水平和休克指数显着升高(2.85±1.37vs.4.54±3.63mmol/L,p=0.001,和0.83±0.26vs.1.10±0.51,p<0.001)。相反,第2组的初始心率和体温显着降低(92.5±21.0vs.109.0±28.1拍/分,p<0.001,和37.3±0.8°Cvs.37.0±0.9°C,分别为p=0.011)。Logistic回归分析确定初始体温低,高乳酸水平,和休克指数是手术干预的独立预测因子(分别为p=0.029,p=0.027和p=0.049)。关于PPH的原因,音调在第1组中明显更普遍(57.2%vs.35.2%,p=0.002),而创伤在第2组中明显更普遍(24.5%vs.39.4%,p=0.030)。第2组的总体结果和预后比第1组差。亚组分析显示,合并其他原因的子宫收缩乏力的发生率明显更高,子宫切除术,延迟手术干预组的弥散性血管内凝血病高于立即手术干预组(42.2%vs.69.2%,p=0.027;51.1%vs.73.1%,p=0.049;和17.8%与46.2%,分别为p=0.018)。
结论:表现为乳酸水平和休克指数升高以及体温降低的PPH患者可能是手术治疗对象。此外,对合并其他原因的PPH的宫缩乏力患者立即进行手术干预,可改善预后,减少术后并发症。
BACKGROUND: No standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes and prognoses between patients with PPH who underwent surgical and non-surgical treatment.
METHODS: This retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical (group 1, n = 159) and surgical intervention groups (group 2, n = 71). A subgroup analysis was performed by dividing the surgical intervention group into immediate (n = 45) and delayed surgical intervention groups (n = 26).
RESULTS: Initial lactic acid levels and shock index were significantly higher in group 2 (2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L, p = 0.001, and 0.83 ± 0.26 vs. 1.10 ± 0.51, p < 0.001, respectively). Conversely, initial heart rate and body temperature were significantly lower in group 2 (92.5 ± 21.0 vs. 109.0 ± 28.1 beat/min, p < 0.001, and 37.3 ± 0.8 °C vs. 37.0 ± 0.9 °C, p = 0.011, respectively). Logistic regression analysis identified low initial body temperature, high lactic acid level, and shock index as independent predictors of surgical intervention (p = 0.029, p = 0.027, and p = 0.049, respectively). Regarding the causes of PPH, tone was significantly more prevalent in group 1 (57.2% vs. 35.2%, p = 0.002), whereas trauma was significantly more prevalent in group 2 (24.5% vs. 39.4%, p = 0.030). Group 2 had worse overall outcomes and prognoses than group 1. The subgroup analysis showed significantly higher rates of uterine atony combined with other causes, hysterectomy, and disseminated intravascular coagulopathy in the delayed surgical intervention group than the immediate surgical intervention group (42.2% vs. 69.2%, p = 0.027; 51.1% vs. 73.1%, p = 0.049; and 17.8% vs. 46.2%, p = 0.018, respectively).
CONCLUSIONS: Patients with PPH presenting with increased lactic acid levels and shock index and decreased body temperature may be surgical candidates. Additionally, immediate surgical intervention in patients with uterine atony combined with other causes of PPH could improve prognosis and reduce postoperative complications.