目的 分析产后出血预测评分与产妇凝血指标的相关性,以及出血预测评分对阴道分娩产后出血的预测效能。方法 采用回顾性研究,纳入2021年1月—2022年12月河南科技大学第二附属医院收治的136例阴道分娩产妇,根据产后出血情况,将合并产后出血的36例患者列为病例组,其余100例列为对照组,比较两组患者的产后出血预测评分及凝血指标,经Spearman相关性系数验证产后出血预测评分结果与凝血指标的相关性,依据实际出血情况,验证产后出血预测评分、各凝血指标对产后出血的预测效能。结果 病例组患者的产后出血预测评分为（7.33±2.46）分,D-二聚体（D-D）为（2.62±0.41）mg/L,均高于对照组[（6.14±2.06）分、（2.17±0.45）mg/L],纤维蛋白原（FIB）为（4.42±1.25）g/L,低于对照组（5.23±1.16）g/L;活化部分凝血活酶时间（APTT）为（37.44±10.25）s,凝血酶原时间（PT）为（15.45±4.12）s,凝血酶时间（TT）为（16.77±4.25）s,均高于对照组[（30.11±10.12）s、（12.49±4.11）s、（13.34±4.18）s],差异具有统计学意义（P<0.05）。经Spearman相关性系数分析,产后出血预测评分与经阴道分娩产妇的D-D、APTT、PT、TT呈正相关,与FIB呈负相关。通过绘制受试者工作特征曲线（ROC）后得知,产后出血预测评分及凝血指标对产后出血均有一定预测价值,但产后出血预测评分的AUC值大于各凝血指标。结论 产后出血预测评分与产妇凝血功能指标呈正相关,将产后出血预测评分与凝血指标检测相结合能实现对产后出血的早期识别及诊断。

Objective To analyze the correlation between postpartum bleeding prediction score and maternal blood coagulation index and the prediction efficiency of postpartum bleeding in vaginal delivery．Methods This is a retrospective study．The cases were included from January 2021 to December 2022．The subjects of the study were 136 vaginal delivery mothers． According to the delivery situation,36 patients with postpartum bleeding were included in the case group,and the rest 100 patients were included in the control group．The postpartum bleeding prediction score and coagulation indicators of the two groups were compared．The correlation between postpartum bleeding prediction score and coagulation indicators was verified by Spearman correlation coefficient．According to the actual bleeding situation,verify the predictive score for postpartum bleeding and the diagnostic efficacy of various coagulation indicators on postpartum bleeding．Results According to the test,the predictive score for postpartum bleeding in the case group was（7.33±2.46）,D-dimer（D-D）was（2.62±0.41）mg/L,which were higher than those in the control group [（6.14±2.06）,（2.17±0.45）mg/L]．Fibrinogen（FIB）was（4.42±1.25）g/L,lower than the control group（5.23±1.16）g/L,activated partial thromboplastin time（APTT）was（37.44±10.25）s,prothrombin time（PT）was（15.45±4.12）s,and thrombin time（TT）was（16.77±4.25）s．Compared with the control group [（30.11±10.12）s,（12.49±4.11）s,and（13.34±4.18）s）],the above indicators were all higher（P<0.05）．Through Spearman correlation coefficient analysis,the predictive score of postpartum bleeding was positively correlated with the D-D,APTT,PT,TT,negatively correlated with the FIB of the parturient who delivered through vagina．After drawing the ROC curve,it was found that both the postpartum hemorrhage prediction score and coagulation indicators had certain predictive value for postpartum hemorrhage,but the AUC value of the postpartum hemorrhage prediction score was greater than each coagulation indicator．Conclusions The prediction score of postpartum bleeding is positively correlated with the coagulation function indicators of the parturient,combining the score and indicators can achieve early identification and diagnosis of postpartum bleeding．

       目的   探讨阴道分娩后尿失禁患者疾病应对方式的影响因素。方法   选取2022年1月—2023年1月医院收治的阴道分娩后尿失禁患者78例，评估所有患者的应对方式，根据结果分为积极应对组与消极应对组，设计基线资料调查表，详细统计两组患者的基线资料并比较，重点分析阴道分娩后尿失禁患者疾病应对方式的影响因素。结果   经评估，78例阴道分娩后尿失禁患者疾病消极应对有40例，占比51.28%；积极应对组与消极应对组患者的产次（χ ² =4.110，P=0.043）、文化水平（Z=2.094，P=0.036）、家庭关怀度（Z=2.069，P=0.040）与自我效能（Z=2.249，P=0.025）比较差异有统计学意义，组间年龄（t=0.096，P=0.924）、孕次（t=1.257，P=0.212）、体质指数（BMI）（t=0.125，P=0.901）、工作（χ ² =0.778，P=0.378）、家庭月人均收入（χ ² =0.044，P=0.834）、漏尿（χ ² =0.040，P=0.842）比较差异无统计学意义；经回归分析发现，家庭关怀度低（OR=1.799，P=0.041）、自我效能低（OR=1.942，P=0.026）、经产妇（OR=2.554，P=0.045）及文化水平低（OR=1.837，P=0.038）均是阴道分娩后尿失禁患者疾病应对方式的影响因素。结论   阴道分娩后尿失禁患者疾病消极应对风险高，可能与产次、文化水平、家庭关怀度及自我效能有关。

       Objective To explore the influencing factors of disease coping strategies in patients with urinary incontinence after vaginal delivery．Methods A total of 78 patients with urinary incontinence after vaginal delivery admitted to the hospital from January 2022 to January 2023 were selected．The coping strategies of all patients were evaluated，and they were divided into a positive coping group and a negative coping group based on the results．A baseline data questionnaire was designed，and the baseline data of the two groups of patients were compared in detail．The focus was on analyzing the factors influencing the disease coping strategies of patients with urinary incontinence after vaginal delivery．Results After evaluation，40 out of 78 patients with urinary incontinence after vaginal delivery had negative coping strategies，accounting for 51.28%．The parity of patients in the positive and negative coping groups（χ ² =4.110，P=0.043），educational level（Z=2.094，P=0.036），family care（Z=2.069，P=0.040），and self-efficacy（Z=2.249，P=0.025）among the groups were different．Age between groups（t=0.096，P=0.924），gestational age（t=1.257，P=0.212），body mass index（t=0.125，P=0.901），and work experience（χ ² =0.778，P=0.378），monthly per capita income of households（χ ² =0.044，P=0.834），urinary leakage（χ 2 =0.040，P=0.842）had no statistically significant difference in comparison．Through regression analysis，it was found that low family care（OR=1.799，P=0.041），low self-efficacy（OR=1.942，P=0.026），postpartum women（OR=2.554，P=0.045），and low educational level（OR=1.837，P=0.038）were all influencing factors on the disease coping strategies of patients with urinary incontinence after vaginal delivery．Conclusions  Patients with urinary incontinence after vaginal delivery have a higher risk of negative coping with the disease，which may be related to parity，educational level，family care and self-efficacy．