慢性HBV感染对产后出血的影响及护理体会

摘要

目的：探讨不同HBV感染状态对产后出血发生率的影响。方法利用医院电子病历系统回顾性收集首都医科大学附属北京地坛医院分娩的HBV感染孕妇和非HBV感染孕妇，根据HBV感染状态分为慢性HBV携带组（A组）、非活动性HBsAg携带组（B组）、CHB组（C组）和非HBV感染组（U组），比较各组孕妇产后出血发生率。结果共收集到符合条件孕妇4217例，其中A组1726例，B组1134例， C组546例，U组811例。各组孕妇年龄、肝功能差异均有显著统计学意义（P均=0.000），但其PTA、纤维蛋白原水平差异无统计学意义（P=0.717、0.714）。A、B、C、D组孕妇产后出血发病率分别为6.7%（115/1726）、6.9%（78/1134）、4.9%（27/546）、8.0%（65/811），差异无统计学意义（P =0.177）。可能引起产后出血的其他高危因素，如羊水过多、羊水Ⅲ度粪染、剖宫产率、新生儿出生体重、身长，各组比较差异无统计学意义。结论不同HBV感染状态在未影响凝血功能情况下不增加产后出血的发生率。HBV感染孕妇孕期应加强肝功能监测，积极治疗肝病，防止产后出血的发生。%Objective To discuss the effect of different status of hepatitis B virus (HBV) infection on the incidence of postpartum hemorrhage. Methods Pregnant women with or without HBV infection who were delivered in the Beijing Ditan hospital, Capital Medical University were retrospectively collected through the HIS system. They were divided into four groups: chronic HBV carriers (group A), inactive HBsAg carriers (group B), chronic hepatitis B (group C) and without HBV infection (group U). Comparison between each group with incidence rate of postpartum hemorrhage. Results Total of 4217 pregnant women meet the requirements were collected, 1726 cases in group A, 1134 cases in group B, 546 cases in group C and 811 cases in group U. The difference of liver function and age were signiifcantly different in the four groups (both P=0.000), but the level of prothrombin time activity and ifbrinogen had no signiifcant differences (P=0.717, 0.714). The incidence of postpartum hemorrhage in the four groups were 6.7%(115/1726), 6.9%(78/1134), 4.9%(27/546), 8.0%(65/811), respectively and compared with no signiifcant difference (P=0.177). High risk factors of postpartum hemorrhage, such as polyhydramnios, amniotic fluid meconium staining ofⅢdegrees, cesarean section rate, neonatal birth weight and body length, had no signiifcant difference among groups. conclusions The incidence of postpartum hemorrhage did not changed by different status of HBV infection with normal coagulative function. To prevent the occurrence of postpartum hemorrhage, pregnant women with HBV infection should strengthen the monitoring of liver function and treat liver disease actively.