| 严小丽,黄革,阎萍,刘鹤莺,常青,王丹.超声评分系统联合临床特征列线图预测凶险性前置胎盘患者产后出血[J].中国医学影像技术,2024,40(3):401~406 |
| 超声评分系统联合临床特征列线图预测凶险性前置胎盘患者产后出血 |
| Nomogram of ultrasound scoring system combined with clinical features for predicting postpartum hemorrhage in patients with pernicious placenta previa |
| 投稿时间：2023-09-18 修订日期：2023-12-15 |
| DOI：10.13929/j.issn.1003-3289.2024.03.017 |
| 中文关键词: 前置胎盘 产后出血 超声检查 列线图 |
| 英文关键词:placenta previa postpartum hemorrhage ultrasonography nomograms |
| 基金项目:重庆市卫生适宜技术推广项目(2022jstg050)。 |
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| 中文摘要: |
| 目的 观察基于超声评分系统联合临床特征构建的列线图预测凶险性前置胎盘(PPP)患者产后出血(PPH)的价值。方法 回顾性分析342例接受剖宫产PPP孕妇,以243例产前接受超声评分系统评估者为观察组、99例接受常规超声者为对照组。比较组间孕妇基线资料及母儿结局差异;记录观察组产后24 h内出血量、判断是否发生PPH(≥1 000 ml),并按8 ∶ 2比例分为训练集(n=194,含107例PPH和87例非PPH)及测试集(n=49,含29例PPH和20例非PPH)。采用单因素及多因素logistic回归分析评估训练集临床及超声系统评分,筛选PPP患者发生PPH的独立危险因素并构建列线图,评估其预测效能、拟合度及临床有效性。结果 观察组产后24 h内出血量、输注红细胞悬液量、手术时间、住院时间及分娩孕周与对照组差异均有统计学意义(P均＜0.05)。产前体质量指数≥28 kg/m2、引产/流产次数≥3及超声系统评分≥10均为PPP患者发生PPH的独立危险因素(P均＜0.05);以之构建的列线图拟合度佳,预测测试集PPP患者发生PPH的曲线下面积为0.81,且阈值为0.22~0.98时临床净获益大于0。结论 超声评分系统联合临床特征列线图能有效预测PPP患者发生PPH。 |
| 英文摘要: |
| Objective To observe the value of the nomogram constructed based on ultrasound scoring system combined with clinical features for predicting postpartum hemorrhage (PPH) in patients with pernicious placenta previa (PPP). Methods Data of 342 PPP pregnant women underwent cesarean section were retrospectively analyzed, including 243 underwent prenatal ultrasound scoring system evaluation (observation group) and 99 underwent routine ultrasound (control group). The maternal baseline data, maternal and infant outcomes were compared between groups. The amount of blood loss within 24 h postpartum of the observation group were recorded, and PPH was diagnosed when blood loss≥1 000 ml. Patients in observation group were divided into training set (n=194, including 107 PPH and 87 non-PPH) and test set (n=49, including 29 PPH and 20 non-PPH) at the ratio of 8 ∶ 2. Then the clinical data and ultrasound scores of training set were analyzed using univariate and multivariate logistic regression, the independent risk factors for PPH in PPP patients were screened and a nomogram was constructed. The predictive efficacy, fit degree and clinical effectiveness of the nomogram were assessed. Results Significant differences of the amount of blood loss within 24 h after delivery, the amount of red blood cell suspension transfused, the time of operation, the time of hospital stay and the gestational week of delivery were detected between groups (all P＜0.05). The prenatal body mass index≥28 kg/m2, the number of labor induction/abortion≥3 and the score of ultrasound scoring system≥10 were all independent risk factors for PPH in PPP patients (all P＜0.05), then the nomogram was constructed, which had good fit. The area under the curve of the nomogram model for predicting PPH in patients with PPP in test set was 0.81. When the threshold was 0.22—0.98, the clinical net benefit was greater than 0. Conclusion Ultrasound scoring system combined with clinical features nomogram could be used to effectively predict PPH in PPP patient. |
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