围产期子宫切除术后再次行腹腔探查术患者的临床特点分析  

Re-exploration after peripartum hysterectomy in postpartum hemorrhage

作　　者：戴满花[1] 刘慧姝[1] 陈敦金[1] 苏向辉[1] 黄天晴[1] 黄东健[1] 

机构地区：[1]广州市重症孕产妇救治中心,广州医学院第三附属医院,510150

出　　处：《中华围产医学杂志》2011年第1期34-38,共5页Chinese Journal of Perinatal Medicine

基　　金：广州市教育局科研基金（61060）;广东省卫生厅科研基金（A2005558）

摘　　要：目的 探讨产后出血围产期子宫切除术后再次腹腔探查手术的原因及临床特点.方法 回顾性分析1999年1月至2009年7月广州市重症孕产妇救治中心收治的88例产后出血致围产期子宫切除病例,其中14例为再次探查手术组,74例为非再次探查手术组.比较两组的如下各项指标：分娩方式、子宫切除指征及方式、再次探查手术的间隔时间及手术方式、并发症、失血量、输血量、格拉斯哥评分、呼吸机辅助呼吸率、重症监护病房入住率、重症监护病房入住时间、住院时间及结局等.结果 88例围产期子宫切除患者中再次探查手术者14例,发生率为15.91%,均因子宫切除后腹腔内出血行再次探查手术.再次探查手术组患者并发弥漫性血管内凝血的比例显著高于非再次探查手术组（92.9%与43.2%,x2=11.598,P=0.001）,同时羊水栓塞比例也显著增高（28.6%与2.7%,x2=8.663,P=0.003）.再次探查手术止血方式：宫颈残端切除（5例）,残端缝扎止血（8例）和右附件切除及腹膜后血肿清除（1例）.再次探查手术组比非再次探查手术组患者具有更高的出血量、输血量、重症监护病房入住率及呼吸机辅助呼吸率[（8752.9±4593.0）ml与（3742.4±2689.9）ml,P=0.000;（8163.6±3903.1）ml与（2958.8±2323.0）ml,P=0.000;100.0%与41.9%,P=0.000;100.0%与24.3%,P=0.000];同时格拉斯哥评分≤8分比例及多器官功能障碍综合征比例显著增高（71.4%与25.7%,x2=9.179,P=0.002;71.4%与14.9%,x2=17.735,P=0.000）;且ICU入住时间及住院时间明显延长[ICU入住时间：（11.4±10.0）d与（1.3±2.3）d;住院时间：（24.0±13.1）d与（12.7±7.0）d,P均=0.000].14例患者均临床痊愈出院.结论 围产期子宫切除术后再次探查手术的发生率不低,腹腔内出血是再次探查手术的主要原因.再次探查手术可能与凝血功能障碍及子宫切除方式选择不当等有关.再次探查手术患者并发症严重.Objective To analyse the causes and clinical characteristics of re-exploration after peripartum hysterectomy due to postpartum hemorrhage. Methods Clinical data was analysed retrospectively including 88 critically ill obstetric patients who underwent peripartum hysterectomy due to postpartum hemorrhage in the Obstetric Critical Care Center of Guangzhou from January 1999 to July 2009, which were divided into re-explored group （n= 14） and non-re-explored group （n=74）depending on whether the patient underwent re-exploration after peripartum hysterectomy. The main demographic data and clinical details were compared between the two groups, including mode of delivery, indication and type of hysterectomy, interval from hysterectomy to re-exploration, surgical intervention, complications, blood loss, blood transfusion,Glasgow Coma Score（GCS）, the need for mechanical ventilation, intensive care unit stay and hospital stay. Results Fourteen out of the 88 （15.91%） patients underwent re-exploration due to internal bleeding after peripartum hysterectomy.Removal of cervical stump was performed in five patients and stump hemostasis in eight cases.Significant difference was found between the re-exploration and non-re-explored group on thepercentage of patients complicated with disseminated intravascular coagulation（92.9% vs 43.2%,x2=11.598,P=0.001） and amniotic fluid embolism （28.6% vs 2.7%, x2 =8.663, P=0.003）.0.000], blood transfusion [（8163.6± 3903.1 ） ml vs （2958.8± 2323.0） ml, P = 0.000], intensive care unit admission rate （100.0% vs 41.9%, x2 = 15.909, P= 0.000）, the need for mechanical ventilation （100.0% vs 24.3%,P=0.000）, the number of patients with GCS≤8 score （71.4% vs 25.7% ,x2 = 9.179, P = 0.002 ）, the number of multiple organ dysfunction syndrome （ 71.4% vs 14.9%, x2 = 17.735, P = 0.000）, intensive care unit stay [ （ 11.4 ± 10.0 ） d vs （ 1.3 ± 2.3 ） d, P =0.000] and hospital stay[（24.0±13.1） d vs （12.7±7.0） d, P=0.000]. Allof the 14 cases were

关 键 词：产后出血 子宫切除术 再手术 

分 类 号：R719.8[医药卫生—妇产科学]