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本公眾號每天分享一篇最新一期Anesthesia & Analgesia等SCI雜志的摘要翻譯,，敬請關注并提出寶貴意見 Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies 背景與目的 與產(chǎn)前剖宮產(chǎn)相比,，產(chǎn)時剖宮產(chǎn)的產(chǎn)婦發(fā)生產(chǎn)后嚴重大出血（PPH）的危險性更高。為了研究產(chǎn)前與產(chǎn)時行剖宮產(chǎn)的產(chǎn)婦間個體危險因素與PPH之間的關系,，我們有必要采用分層分析的方法,。 方 法 為了研究兩組剖宮產(chǎn)（產(chǎn)前剖宮產(chǎn)與產(chǎn)時剖宮產(chǎn)）產(chǎn)婦發(fā)生PPH的危險因素，我們設計了兩組病例對照研究組,。每組中的產(chǎn)婦均于2002年-2012年間在美國三級產(chǎn)科中心分娩,，且這些產(chǎn)婦出血量≧1500ml或分娩后48小時內(nèi)接受了術中或術后輸血。采用獨立邏輯回歸分析來評價產(chǎn)前或產(chǎn)時行剖宮產(chǎn)的產(chǎn)婦產(chǎn)后發(fā)生PPH的危險因素,。 結 果 我們納入了269例產(chǎn)前行剖宮產(chǎn)的病例組和550例對照組,。發(fā)生PPH比率最高的危險因素為全身麻醉（優(yōu)勢比=22.3；95%可信區(qū)間=4.9-99.9,；對照組=蛛網(wǎng)膜下腔阻滯麻醉）,，其他危險因素：多胎妊娠（優(yōu)勢比=8.0；95%可信區(qū)間=4.2-15.0,；對照組=單胎妊娠）,、前置胎盤（優(yōu)勢比=6.3；95%可信區(qū)間=3.4-11.8）,。我們納入了278例產(chǎn)時行剖宮產(chǎn)的病例組和572例對照組,。發(fā)生PPH比率最高的危險因素也為全身麻醉(優(yōu)勢比=5.4；95%可信區(qū)間=1.7-17.1),，其他危險因素為：多胎妊娠（優(yōu)勢比=3.2,；95%可信區(qū)間=1.7-6.3）；一例分娩前血紅蛋白≤9.9g／dl（優(yōu)勢比=3.0,；95%可信區(qū)間=1.3-6.9）,，對照組血紅蛋白=分娩前血紅蛋白≧11g／dl. 結 論 無論是產(chǎn)前行剖宮產(chǎn)的產(chǎn)婦，還是產(chǎn)時行剖宮產(chǎn)的產(chǎn)婦,，發(fā)生PPH都有同樣的危險因素：全身麻醉與多胎妊娠,。然而，研究組中發(fā)生PPH的危險因素還是存在些許區(qū)別,，了解這些差異,，在對產(chǎn)前或產(chǎn)時行剖宮產(chǎn)的高危產(chǎn)婦進行麻醉計劃和干預措施時尤為重要。 原始文獻摘要 Butwick A J, Ramachandran B, Hegde P, et al. Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies[J]. Anesthesia & Analgesia, 2017, 125(2):523. BACKGROUND: Women who undergo intrapartum caesarean delivery (CD) are at increased risk of postpartum hemorrhage (PPH) compared with those undergoing prelabor CD. To determine whether the presence and strength of the associations between individual risk factors and severe PPH vary among women undergoing prelabor CD or intrapartum CD, stratified analyses are needed according to CD subtype. METHODS: To identify risk factors for severe PPH within 2 distinct CD populations, prelabor CD and intrapartum CD, we performed 2 case-control studies. Women in each study cohort delivered at a tertiary obstetric center in the United States between 2002 and 2012. For each study, cases were women who had a blood loss ≥1500 mL or who received an intraoperative or postoperative transfusion up to 48 hours after delivery. Risk factors for severe PPH among women undergoing prelabor CD or intrapartum CD were examined in separate logistic regression models. RESULTS: For prelabor CD, we identified 269 cases and 550 controls. Clinical factors with the highest adjusted odds for severe PPH during prelabor CD were general anesthesia (adjusted odds ratio [aOR] = 22.3; 95% confidence interval [CI], 4.9–99.9; reference group = spinal anesthesia), multiple pregnancies (aOR = 8.0; 95% CI, 4.2–15.0; reference group = singleton pregnancy), and placenta previa (aOR = 6.3; 95% CI, 3.4–11.8). For intrapartum CD, we identified 278 cases and 572 controls. Clinical factors with the highest adjusted odds for severe PPH during intrapartum CD were general anesthesia (aOR = 5.4; 95% CI, 1.7–17.1), multiple pregnancies (aOR = 3.2; 95% CI, 1.7–6.3), and a predelivery hemoglobin ≤ 9.9 g/dL (aOR = 3.0; 95% CI, 1.3–6.9; reference group = predelivery hemoglobin ≥ 11 g/dL). CONCLUSIONS: Women who undergo prelabor CD and intrapartum CD have several shared risk factors for severe PPH (general anesthesia and multiple pregnancies). However, the risk factor profiles for severe PPH differed between these CD cohorts. Recognizing these differences may be important when planning resources and interventions for high-risk patients undergoing either prelabor or intrapartum CD. 麻醉學文獻進展分享 |
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