改良式多U型子宫压迫缝合术在难治性产后出血中的临床应用

发布时间：2018-06-22 11:05

  本文选题：U型缝合 + 子宫压迫缝合　； 参考：《山东大学》2017年硕士论文

【摘要】：目的:探讨山东大学齐鲁医院剖宫产术中发生难治性产后出血(PPH)的可能高危因素以及导致出血的主要原因。评估改良式多U型子宫压迫缝合术对剖宫产术中难治性PPH患者的临床治疗效果及预后。方法:对山东大学齐鲁医院妇产科2013年1月至2016年3月收住院行剖宫产术治疗的难治性PPH患者42例(出血组)及按1:3的匹配方式随机抽取的126例未发生产后出血的正常剖宫产患者(正常组)的临床资料进行回顾性分析。出血组42例患者中经常规处理(按压子宫、缩宫素及欣母沛等促宫缩药物的应用、宫腔纱布或球囊压迫填塞、子宫动脉结扎、"8"字缝合、B-Lynch缝合等)无效而行改良式多U型子宫压迫缝合术10例(以下简称多U型缝合术)(缝合组),经常规处理未行多U型缝合术的患者32例(常规组)。统计方法是采取SPSS 23.0统计学软件进行检验,主要包括卡方及非参数秩和检验。结果:1、通过出血组42例与正常组126例产妇的临床资料比较得知:难治性PPH的可能高危因素为高龄产妇(年龄≥35岁)、既往流产史、多次妊娠史、既往剖宫产手术史(P0.05);2、缝合组10例产妇中因胎盘因素导致的难治性PPH6例(占60%),常规组32例产妇由胎盘因素导致的出血28例(占87.5%),两组均无凝血功能异常的发生,两组出血原因的差异无意义(P0.05);3、缝合组的术中出血量、输红细胞量、麻醉后完整手术时间以及剖宫产术后住院天数分别为 2250.00±716.86ml、6.20±3.19U、120.50±21.79min、4.50±1.96d,常规组的术中出血量、输红细胞量、麻醉后完整手术时间以及剖宫产术后住院天数分别为 3510.00±1877.70ml、12.4±9.46U、148.83±62.74min、7.37±2.61d,差异有统计学意义(P0.05);4、缝合组10例患者术毕出血均被有效控制,均未行子宫切除术,常规组行子宫切除术6例;5、随访缝合组10例患者,恶露消失时间均正常,停止哺乳后均恢复正常月经,复查超声均未发现宫腔粘连等缝合相关并发症,其中2例患者再次妊娠,已足月分娩1例,另外1例患者因术后不足1年妊娠而行流产术。结论:1、产妇高龄状态(年龄≥35岁)、既往流产史、1次及以上妊娠史以及剖宫产手术史为出血的可能高危因素,应对合并有上述危险因素的孕产妇提高警惕,并做好预防措施。其中胎盘因素,尤其是凶险性前置胎盘在难治性PPH中所占的比例逐渐增高。2、改良式多U型子宫压迫缝合术是简便、有效、快速、安全的止血术式,成功率较高,术后并发症少,非常适合于剖宫产术中其他止血方法不能奏效的紧急情况下应用。该术式有利于保留患者的生育功能,极其适用于技术、血源及抢救设备不充足的基层医院,是值得推广及应用的。
[Abstract]:Objective: to investigate the possible high risk factors of intractable postpartum hemorrhage (PPH) during cesarean section in Qilu Hospital of Shandong University and the main causes of PPH. To evaluate the clinical effect and prognosis of modified multiple U type suture for refractory PPH during cesarean section. Methods: from January 2013 to March 2016, 42 patients with refractory PPH who underwent cesarean section in Qilu Hospital of Shandong University (bleeding group) and 126 cases without postpartum hemorrhage were randomly selected according to the matching method of 1:3. The clinical data of patients with normal cesarean section (normal group) were analyzed retrospectively. In the bleeding group, 42 patients were treated by routine treatment (pressing uterus, oxytocin and Xinmu Pei, etc.) uterine gauze or balloon compression tamponade, Uterine artery ligation, "8" suture and B-Lynch suture were ineffective, and 10 cases were treated with modified multi-U suture (hereinafter referred to as multi-U suture) (suture group), and 32 cases (routine group) without multi-U suture. SPSS 23.0 software was used to test the statistical method, including chi-square and nonparametric rank sum test. Results by comparing the clinical data of 42 cases in bleeding group and 126 cases in normal group, the results showed that the risk factors of refractory PPH were elderly women (鈮，

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