摘要
目的为分析妊娠期糖尿病孕产妇产后出血的影响因素并构建列线图(Nomogram)预测模型。方法本研究选取了2022年1月至2023年11月在乐平市妇幼保健院定期产检并分娩的妊娠期糖尿病孕产妇165例作为研究对象,并根据孕产妇是否发生产后出血分为出血组(n=46)和未出血组(n=119)。比较两组患者一般临床资料,多因素Logistic回归分析筛选影响妊娠期糖尿病孕产妇产后出血的独立危险因素,R软件“rms”包构建Nomogram预测模型。结果两组孕产妇本次分娩方式、妊娠期高血压疾病(HDP)、胎膜早破、胎位异常、胎盘异常、羊水过多、宫缩乏力相比差异具有统计学意义(P<0.05)。剖宫产、HDP、胎膜早破、胎位异常、胎盘异常、羊水过多、宫缩乏力是妊娠期糖尿病孕产妇产后出血的独立危险因素(P<0.05)。决策曲线结果显示,风险阈值为0.08~0.97时,此预测模型所提供的临床净收益较高。结论剖宫产、HDP、胎膜早破、胎位异常、胎盘异常、羊水过多、宫缩乏力是妊娠期糖尿病孕产妇产后出血的独立危险因素,基于此构建的Nomogram具有较高的预测效能及临床获益。
Objective To analyze the influencing factors of postpartum hemorrhage in pregnant women with gestational diabetes mellitus(GDM)and establish a Nomogram prediction model.Methods 165 pregnant women with GDM who received regular antenatal check-up and gave birth in Leping Maternal and Child Health Hospital from January 2022 to November 2023 were selected as the study objects,and were divided into hemorrhage group(n=46)and non-hemorrhage group(n=119)according to whether postpartum hemorrhage occurred.General clinical data of the two groups were compared,and multivariate Logistic regression analysis was performed to screen for independent risk factors affecting postpartum hemorrhage in GDM pregnant women.A Nomogram prediction model was constructed with R software"rms"package.Results There were statistically significant differences in the mode of delivery,pregnancy-induced hypertension(HDP),premature rupture of membranes,fetal position abnormality,placenta abnormality,excessive amniotic fluid and uterine fatigue between the two groups(P<0.05).The cesarean section,HDP,premature rupture of membranes,abnormal fetal position,abnormal placenta,excessive amniotic fluid and uterine weakness were independent risk factors for postpartum hemorrhage in GDM women(P<0.05).The results of the decision curve show that when the risk threshold ranges from 0.08 to 0.97,the prediction model provides a higher clinical net benefit.Conclusion Cesarean section,HDP,premature rupture of membranes,abnormal fetal position,abnormal placenta,excessive amniotic fluid,and weak contraction are independent risk factors for postpartum hemorrhage in women with GDM.This Nomogram has high predictive efficacy and clinical benefits.
作者
甘跃敏
Gan Yuemin(Leping Maternal and Child Health Hospital,Leping Jiangxi 333300,China)
出处
《药品评价》
CAS
2024年第4期481-485,共5页
Drug Evaluation
基金
景德镇市科技计划项目(20222SFZC064)。
关键词
妊娠期糖尿病
产后出血
影响因素
列线图
Gestational diabetes mellitus
Postpartum hemorrhage
Influencing factors
Nomogram
