剖宫产致产后出血经介入治疗失败后行子宫全切术9例报道  

Retrospective Analysis of Cesarean Hysterectomy Treated with Intervention of Postpartum Hemorrhage in 9 Cases

作　　者：罗静[1] 吕毅[2] 罗亚彬 

机构地区：[1]昆明医科大学附属甘美医院产科,云南昆明650031 [2]上海交通大学医学院附属第六人民医院麻醉科,上海200233

出　　处：《昆明医科大学学报》2013年第11期97-101,共5页Journal of Kunming Medical University

摘　　要：目的：探讨剖宫产子宫切除术与介入治疗的指征、时机及风险预测．方法回顾性分析2012年1月至2013年1月行子宫下段剖宫产术发生产后出血经介入治疗后仍行子宫全切术病例9例患者的临床资料，记录患者手术指征、疾病特点、各阶段手术用时及出血量相关参数．结果引起产后出血剖宫产手术最常见指征为凶险性前置胎盘，占56%，依次为Ⅲ度胎盘早剥、重度子痫前期．剖宫产手术中出血占总出血量的62％～70%．抢救总耗时（7.4±1.4） h，总出血量（7100±2250） mL．发生凝血功能障碍与手术时间、术中出血量呈显著相关性．结论对于具有疤痕子宫、前置胎盘、胎盘早剥、多孕多产等高危因素的剖宫产引起的产后出血，必须放宽指征及时切除子宫；产后出血早期进行介入治疗对于降低子宫切除率，减少术中、术后失血有重要意义．Objective To investigate the indication, occasion and risk predication of cesarean hysterectomy and interventional treatment. Methods The clinical data of 9 patients with low cesarean section postpartum hemorrhage that underwent hysterectomy after interventional treatment from January 2012 to January 2013 were analyzed which included surgical indication, disease characteristics, procedure time, bleeding volume and other parameters. Results The most common surgical indication for cesarean that caused postpartum hemorrhage was dangerous placenta previa, accounting for 56%, followed byⅢdegree of placental abruption and preeclampsia. The surgical bleeding of cesarean accounted for 62%-70%of the total amount of bleeding. The total time of rescue was 7.4 ± 1.4 hours. The total amount of bleeding was 7 100 ± 2 250 mL. The occurrence of coagulation disorder was significantly correlated with surgical time and amount of blood loss. Conclusion For postpartum hemorrhage caused by cesarean section with risk factors such as scar uterus, placenta previa, placental abruption, many pregnant prolific and others, we must relax indications of hysterectomy. With future treatment potential, the early intervention of postpartum hemorrhage also plays an important role in reducing hysterectomy rate, reducing intraoperative and postoperative blood loss.

关 键 词：剖宫产 产后出血 介入治疗 子宫切除 

分 类 号：R714.461[医药卫生—妇产科学]