产后出血性疾病应用介入治疗61例临床分析

发布时间：2018-05-27 19:10

本文选题：产后出血 + 介入治疗　；参考：《吉林大学》2015年硕士论文

【摘要】：妇产科血管性介入治疗技术，作为介入放射学的一个分支是治疗妇产科出血性疾病，挽救患者生命、保留生育功能的重要手段及措施。随着近年来医疗技术的不断发展，从以往单一手术方式治疗产科潜在出血性疾病的方案，演变为今天可供选择的多种治疗方式，其中介入治疗应用在产科出血性疾病尤其是产后出血中越来越多。目的：探讨产后出血性疾病应用介入治疗的相关因素。方法： 1、回顾性分析2010年1月至2015年1月吉林大学第一、第二临床医院收治的61孕产妇因产后出血行介入治疗的病历资料。病例资料包括孕产妇的年龄、孕育时间、孕育史、其他并发疾病症状等，会包括产妇生产情况，如出血量、分娩方式等。分析各种因素对于孕产妇生产的影响。 2、将数据采用SPSS19.0统计学软件进行处理，采用t检验和2检验进行分析。结果：调查61例产后出血行介入治疗患者中，外院分娩后转入吉大一院与我院进行介入治疗19例，于本院分娩后出血行介入治疗42例。行介入治疗患者中16例前置胎盘合并胎盘植入，12例宫缩乏力，11例前置胎盘，胎盘粘连、植入患者10例，胎盘早剥6例，妊娠合并子宫肌瘤6例。47例患者有人工流产史者，36例有剖宫产史；正常分娩的患者有6例，采用剖宫产术终止妊娠者55例，所有研究对象中，最终均存活，无死亡病例。对所有研究对象产后出血的因素进行分析，发现胎盘因素占第一位，具体包括胎盘前置、粘连、早剥等。其对导致子宫出血存在明显意义。结论：介入治疗是治疗产后出血、保留患者子宫、挽救患者生命的有效措施之一。产科出血性疾病包括前置胎盘、产后出血、瘢痕妊娠等，，其均可导致患者大量出血，严重危及患者生命。其中产后出血应用介入治疗方式取得显著效果，并随经济增长、人们文化水平程度提高而使用率呈逐年上升趋势。切实做好优生优育、孕妇怀孕期间以及产妇分娩期间的相关保健工作，较大预防力度，对健康分娩做正确宣传。近年来，分娩率不断上升，剖宫产率也随之增加，无指证剖宫产逐年增加，以及政府放宽二胎政策，这些政策性因素以及社会因素都会影响到孕产妇的生产方式的选择，增加产后出血的可能性，而其避免措施就是尽量减少子宫操作，如减少剖宫产使用的几率，从而减少子宫瘢痕的形成，降低孕产妇再次妊娠的危险因素。一经发现产后出血的患者，及时评估患者，及时制定治疗方案，迅速选择针对患者病情的治疗措施，就会大大降低患者发生难以接受后果的概率。
[Abstract]:As a branch of interventional radiology, vascular interventional therapy in obstetrics and gynecology is an important method and measure to treat gynaecology and obstetrics hemorrhagic diseases, save patients' lives and preserve fertility function. With the continuous development of medical technology in recent years, the single surgical treatment of potentially hemorrhagic obstetric diseases has evolved from a single procedure to a variety of treatments available today. Interventional therapy is used more and more in obstetrical hemorrhagic diseases, especially postpartum hemorrhage. Objective: To explore the related factors of interventional therapy for postpartum hemorrhagic diseases. Methods: 1. The medical records of 61 pregnant women undergoing interventional treatment for postpartum hemorrhage in the first and second Clinical Hospital of Jilin University from January 2010 to January 2015 were analyzed retrospectively. Case data include maternal age, gestation time, gestation history, symptoms of other concurrent diseases, etc., including maternal birth conditions, such as bleeding, delivery methods and so on. The influence of various factors on maternal production was analyzed. 2. The data were processed by SPSS19.0 statistical software, and analyzed by t test and 2 test. Results: Among 61 patients with postpartum hemorrhage undergoing interventional therapy, 19 cases were transferred to Jida first Hospital and our hospital after delivery, and 42 cases were treated with interventional therapy after delivery in our hospital. There were 16 cases of placenta previa with placenta accreta and 12 cases of uterine accretion, 11 cases of placenta previa, placenta adhesion, 10 cases of placenta accreta, 6 cases of placental abruption, and 12 cases of pregnancy complicated with pregnancy. There were 6 cases of uterine leiomyoma with history of induced abortion and 36 cases of cesarean section, and 6 cases of normal delivery and 55 cases of termination of pregnancy by cesarean section. By analyzing the factors of postpartum hemorrhage in all the subjects, we found that placenta was the first factor, including placenta previa, adhesion, abruption and so on. It has obvious significance to cause uterine bleeding. Conclusion: Interventional therapy is one of the effective measures to treat postpartum hemorrhage, preserve uterus and save patient's life. Obstetrical hemorrhagic diseases include placenta previa postpartum hemorrhage scar pregnancy and so on. The effect of interventional therapy on postpartum hemorrhage was significant, and with the economic growth, the educational level of people increased and the utilization rate increased year by year. Do a good job of health care during pregnancy and delivery of pregnant women, do a good job of prevention, and make correct propaganda for healthy delivery. In recent years, the rate of delivery has been rising, the rate of cesarean section has also increased, the number of undocumented caesarean sections has increased year by year, and the government has relaxed its policy on second births. These policy factors and social factors will affect the choice of the mode of production of pregnant women. To increase the possibility of postpartum hemorrhage, the measures to avoid it are to minimize uterine operation, such as reducing the chance of using cesarean section, thus reducing the formation of uterine scar and reducing the risk factors of pregnancy. Once the patient with postpartum hemorrhage is found, the patient is evaluated in time, the treatment plan is made in time, and the treatment measure is chosen quickly, the probability of unacceptable consequences will be greatly reduced.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R714.461

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