产后出血一线治疗无效的影响因素及外科处理对策  

Risk Factors and Surgical Interventions Associated with Primary Postpartum Hemorrhage Unresponsive to First-line Therapies

作　　者：颜建英[1] 周志梅[2] 徐霞[2] 黄晓燕[1] 徐榕莉[1] 林顺和[1] 

机构地区：[1]福建医科大学福建省妇幼保健院教学医院妇产科,福州350001 [2]福建医科大学研究生教育学院,福州350004

出　　处：《福建医科大学学报》2012年第4期261-265,共5页Journal of Fujian Medical University

基　　金：福建省科技计划重点项目(2009Y0008);福建省卫生厅医学创新课题(2009-CXB-32)

摘　　要：目的探讨产后出血一线治疗无效的影响因素及外科处理对策。方法回顾性分析2008年12月-2009年12月系统产检并住院分娩的212例产后出血产妇的临床资料。根据疗效分为一线治疗无效需外科处理的产后出血产妇74例为观察组,一线治疗有效无需外科处理的产后出血产妇138例为对照组;观察组根据一线治疗无效后采取的第一个二线治疗措施再分为宫腔填塞组(19例)、B-lynch术组(27例)和子宫动脉结扎组(28例)。比较分析一线治疗无效的影响因素并探讨外科处理对策。结果 (1)观察组和对照组产妇年龄、产前体质量指数(BMI)、孕次、产次、分娩孕周和应用宫缩剂的剂量与按摩子宫的比例比较,差别无统计学意义(P>0.05);观察组产后出血量、剖宫产率高于对照组,差别有统计学意义(P<0.05)。(2)非条件Logistic回归分析提示,异常胎盘附着(OR=3.823,95%CI:1.333～10.963,P=0.013)和剖宫产(OR=2.745,95%CI:1.063～7.085,P=0.037)是产后出血一线治疗疗效的危险因素。(3)一线治疗无效后,作为第一个二线治疗方法,宫腔填塞组、B-lynch术组和子宫动脉结扎组的有效率、产后出血量及输血量比较差别均无统计学意义(P>0.05)。(4)宫缩乏力是产妇产后出血的主要原因(66.04%)。结论 (1)异常胎盘附着和剖宫产是产后出血一线治疗疗效的独立危险因素。(2)产后出血最常见的原因是宫缩乏力,及时按摩子宫和或应用宫缩剂加强子宫收缩是处理宫缩乏力性产后出血一线治疗措施。(3)若一线治疗无效,由于操作简单和侵入性小,宫腔纱布或水囊填塞技术是首选的外科治疗措施。Objective To investigate risk factors and surgical interventions associated with primary postpartum hemorrhage（PPH） unresponsive to first-line therapies.MethodsA retrospective analysis of 212 women who attended routine prenatal check-up and experienced primary PPH was performed.Women were classified as responders（as observation group） and non-responders（as control group） according to response to first-line therapies.According to the first second-line therapies,observation group were divided into intrauterine tamponade group,B-Lynch suture group and uterine artery ligation group.Results（1）There was no significant difference in maternal age,antepartum body mass index,gravidity,parity,gestational weeks at delivery,units of uterotonics between observation group and control group（P〉0.05）.There was greater blood loss within the first 24h after delivery and the rate of cesarean section in observation group compared with control group（P〈0.05）.（2）A multivariable stepwise forward logistic regression analysis identified that cesarean section（odds ratio[OR]2.745;95% confidence interval[CI],1.063~7.085;P=0.037） and abnormal placental adhesion（OR 3.823;95%CI,1.333~10.963;P=0.013） were risk factors for PPH unresponsive to first-line therapies.（3）There was no significant difference in blood loss,blood transfusion and successful rate among women who were performed intrauterine tamponade,B-Lynch suture and uterine artery ligation.（4）Uterine atony was the most common cause of PPH（66.04%）.ConclusionsAbnormal placental adhesion and cesarean section were risk factors of PPH unresponsive to first-line therapies.Uterine atony is the most common cause of PPH.Therefore,uterine massage and administration of uterotonics based on the achievement of contraction is first-line therapies for atonic PPH.Since intrauterine tamponade is the least invasive and most rapid approach,it would be taken as the first choice for surgical management after unresponsive to first-line therapies.

关 键 词：产后出血 子宫 外科纱布 止血 缝合技术 动脉 结扎术 

分 类 号：R714.461[医药卫生—妇产科学] R322.65[医药卫生—临床医学]