基于子宫内压与子宫肌电信号的阴道分娩宫缩乏力性产后出血的系统研究

Postpartum hemorrhage occur with high incidence, causing serious complications and a high rate of mortality. Compared with more clinical research, basic reasearch is rarely reported. ..This study aims to deal with the key scientific problems related to "reducing the rate of postpartum hemorrhage". Based on previous work, this study intends to emphasize the application of "intrauterine pressure (IUP) and uterus electromyogram (EMG)". It will also explore the "physiological diagnosis standards of postpartum hemorrhage with atony as well as the application, mechanics, and timing of clinical hemostatic methods". This study includes the following specifics:..(1).The design and development of measurement methods for postpartum intrauterine pressure (IUP) and uterus electromyogram (EMG);.(2).The correlation between postpartum intrauterine pressure (IUP), uterus electromyogram (EMG) and the volume of postpartum hemorrhage, as well as determining their thresholds. .(3).Integrating the risk factors of postpartum hemorrhage, we will construct an artificial neural network model and establish a postpartum hemorrhage prediction system;.(4).The development of diagnosis and treatment systems for postpartum hemorrhage; based on research of mechanism for postpartum hemorrhage with atony, choosing an appropriate liquid dose and time application for use with the Bakri balloon. ..Consequently, this study can provide a theoretical basis for the vaginal delivery of prophylactics intended for the preventative treatment of postpartum hemorrhage, reducing the possibility of subjective judgement by medical staff, achieving more scientific, objective and accurate predictions to achieve the goal of early diagnosis and treatment, effectively reducing the rate of postpartum hemorrhage with atony, decreasing blood loss, to ensure delivery and population quality.

产后出血的发病率高，并发症严重，死亡率高，临床研究较多，但基础研究鲜见报道。本项目针对"降低产后出血率"的关键科学问题，在前期工作基础上，拟以"子宫内压和子宫肌电信号的测定"为主线，探讨"宫缩乏力性产后出血的生理学诊断标准和临床压迫止血的原理及应用时机"。.具体开展以下工作：①设计发明产后子宫内压及子宫肌电信号的测定方法；②研究子宫内压及子宫肌电信号与产后出血量的相关性，并确定阈值；③综合高危因素，构建人工神经元网络模型，确立产后出血预测系统；④开发产后出血诊治系统，基于力学基础研究Bakri球囊最佳压迫止血的液体剂量及其应用时机。.因此，本项目将为阴道分娩宫缩乏力性产后出血的预防性治疗提供理论依据，减少医务人员的主观臆断，实现科学、客观、准确的预测，以及早期诊治的目标，切实降低宫缩乏力性产后出血的发生率，减少出血量，确保分娩质量，提高人口素质。

产后出血的发病率高，并发症严重，目前是中国孕产妇死亡的第一原因。75-90％的产后出血是由子宫收缩乏力引起，但诊断和治疗多凭临床经验，主观性很强。本项目从基础方面入手，研究阴道分娩后的子宫内压（IUP）及子宫肌电信号(EHG)等生物力学及生理学指标，探讨子宫收缩力与所需止血压力之间的关系，明确阴道分娩继发性宫缩乏力诊断的客观指标，建立可同时压迫止血的基于Foley氏导管或Bakri止血球囊的子宫内压测试系统，并综合临床总结筛选的产后出血高危因素、产后子宫内压及子宫体表肌电信号监测等数据，预测阴道分娩宫缩乏力性产后出血的可能性，开发宫缩乏力性产后出血的诊治系统，减少医务人员的主观臆断。. 本项目设计发明产后子宫内压的监测系统并成功应用；在推广应用Bakri宫腔填塞止血球囊的基础上，实时监测产后子宫内压的变化曲线图，分析液体注入量与形成压力的关系，初步总结出其对子宫压迫止血的最佳时机及所需的有效压力；通过临床大样本对照研究，比较启动和未启动诊治系统组产妇的产后出血发生率、产后出血量、产后出血原因的构成比、产后的并发症、输血及治疗情况、母乳喂养及住院天数等指标，评估验证该系统的有效性、安全性及性价比等。第一作者或通讯作者发表与本研究相关标注的SCI期刊论著2篇，国内核心期刊论著9篇，第一发明人获国家发明专利1项，实用新型专利1项，第一完成人获2016年及2013年厦门市科技进步，2016年福建省科技进步奖，2015年厦门市医学创新奖，2013年福建省医学创新奖。 . 本项目基础应用临床，研究阴道分娩宫缩乏力性产后出血的早期诊断、预防性治疗的机理及方法，从而大大降低了产后出血率，避免子宫切除，降低医疗成本，减少医疗纠纷，提高分娩质量，填补国内外空白，具有重大的科学意义。