重度产后出血的原因分析及防治措施  

Analysis of Causes and Management of Severe Postpartum Hemorrhage

作　　者：肖玲[1] 王心[1] 尚丽新[1] 

机构地区：[1]北京军区总医院妇产科,100700

出　　处：《中华妇幼临床医学杂志（电子版）》2013年第5期529-532,共4页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

摘　　要：目的分析重度产后出血(PPH)发生的相关因素,探讨对其预防及治疗的有效措施。方法选择2009年1月至2012年12月在北京军区总医院妇产科住院分娩的重度PPH患者60例为研究对象。对其高危因素进行单因素分析,包括年龄、孕次、产次、子痫前期、妊娠期糖尿病、前置胎盘、胎盘因素、胎儿数、胎儿出生体重、分娩方式、软产道损伤、宫缩乏力、疤痕子宫、会阴侧切(本研究遵循的程序符合北京军区总医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象的知情同意,并与之签署临床研究知情同意书)。结果①重度PPH的主要原因是子宫收缩乏力和胎盘因素。60例患者中,子宫收缩乏力为34例(57%),胎盘因素为7例(12%),腹腔内血肿为1例(2%),软产道损伤为4例(7%),单因素分析显示,年龄、子痫前期、前置胎盘、胎盘因素、胎儿出生体重、软产道损伤、疤痕子宫是重度PPH的高危因素。②39例经行人工按摩子宫、应用促宫缩药物、输血治疗及缝扎止血等常规治疗有效,21例经常规治疗效果不佳,其中8例行B-Lynch缝合术,1例行全子宫切除术,9例行子宫动脉栓塞术,2例行子宫动脉栓塞术+B-Lynch缝合术,1例行子宫动脉栓塞术+右侧卵巢动脉栓塞术+全子宫切除术,均有效止血,无一例死亡。结论对具有重度PPH高危因素者,应积极预防,这对降低重度PPH的发生具有重大意义。Objective To analyze the occurrence of severe postpartum hemorrhage （PPH） and explore effective measures for its prevention and treatment to reduce the incidence of severe PPH. Methods A total of 60 cases of severe PPH from January 2009 to December 2012 in the Beijing Military General Hospital were included in this study. Its risk factors were analyzed by univariate analysis, including age, gravidity, parity, preeclampsia, gestational diabetes, placenta previa, placenta factors, fetal number, fetal birth weight, mode of delivery, soft birth canal injury, uterine inertia, uterine scar, episiotomy. The procedure followed hospital human trails meet the ethical standards established by the Committee, be approved by the committee, all subjects informed consent, and with the informed consent form signed by clinical research. Results （1） The main reasons for severe PPH were uterine inertia and placental factors, 34 cases （57%） of uterine factors, 7 cases （12%） of placental factors, 1 case （2%） of intraperitoneal hematoma, 4 cases （7%,d） of soft canal injury. There were still many risk factors of severe PPH, such as fetal macrosomia, old age, pregnancy complications. （3） The treatment of 39 cases with severe PPH who were given to promoting contractions, transfusion therapy, procoagulant therapy and suture hemostasis were effective. And another 8 cases were received B-Lynch suture, 1 case of hysterectomy, 9 cases of uterine artery emholization, 2 cases of uterine artery embolization ＋ B-Lynch suture, 1 case of uterine artery embolization -k right ovary artery embolization q- hysterectomy, all were effective. Conclusions The pregnancy with risk factors of severe PPH should be taken positive prevention in order to reduce the incidence of severe PPH.

关 键 词：产后出血 病因 预防 治疗 

分 类 号：R714.461[医药卫生—妇产科学]