【摘要】 目的 了解阴道分娩产妇产道血肿形成的危险因素。方法 收集34 945例阴道分娩产妇的临床资料，将发生产道血肿的112例患者纳入产道血肿组，从余下34 833例未形成产道血肿的产妇中随机选取260例作为对照组，共纳入372例产妇，比较产道血肿组与对照组间差异，并进行logistic回归分析阴道分娩产妇产道血肿形成的危险因素。结果 阴道分娩产道血肿形成的发生率为0.32%(112/34 945)。2组产妇的孕次、第一产程时长、第二产程时长、急产者比例、新生儿体质量、分娩巨大儿者比例比较差异均无统计学意义（P均> 0.05）。与对照组相比，产道血肿组的初次分娩、会阴切开、会阴裂伤、阴道裂伤、阴道助产者比例均较高（P均<0.05）。多因素logistic回归分析结果显示，初产妇（OR=1.663,95%CI 1.003～2.757）、阴道裂伤（OR=3.698,95%CI 1.962～6.970）是产道血肿形成的危险因素（P均<0.05）。结论 初次分娩、会阴切开、产道裂伤和阴道助产者易出现产道血肿，临床医师在处理阴道分娩产妇时尤其应关注其是否为初次分娩及是否合并阴道裂伤，及时给予相应处理，改善产妇预后。更多还原

【Abstract】 Objective To assess the risk factors of puerperal genital hematomas in women after vaginal delivery.Methods Clinical data of 34 945 cases of vaginal delivery were reviewed retrospectively. According to the incidence of puerperal genital hematomas, 112 women presenting with puerperal genital hematomas were divided into the genital hematomas group, and 260 randomly selected from 34 833 normal women were assigned into the control group. Clinical data of 372 cases were collected and compared between two groups. The risk factors of puerperal genital hematomas were assessed by logistic regression analysis.Results The total incidence of puerperal genital hematomas was 0.32%(112/34 945) in this study. No statistical significance was observed in the gravidity, first stage of labor time, second stage of labor time, the number of precipitate labor, neonatal birth weight and the number of macrosomia between two groups(all P > 0.05). However, the proportion of nulliparity, episiotomy, perineal laceration, vaginal laceration, and instrumental delivery in the genital hematomas group was significantly higher compared with that in the control group(all P < 0.05). Multivariate logistic regression analysis showed that nulliparity(OR=1.663, 95%CI 1.003-2.757) and vaginal laceration(OR=3.698, 95%CI 1.962-6.970) were risk factors of puerperal genital hematomas(both P < 0.05).Conclusions Nulliparity, episiotomy, perineal laceration, vaginal laceration, and instrumental delivery are associated with a higher rate of puerperal genital hematomas. Clinicians should pay extensive attention to nulliparity and vaginal laceration, deliver effective interventions and improve clinical prognosis of pregnant women after vaginal delivery.更多还原