五种止血手术治疗难治性产后出血的效果比较及止血失败的原因分析  

Effect comparison on five hemostasis surgery in the treatment of intractable postpartum hemorrhage and reason analysis of homeostasis failure

作　　者：林卫琼[1] 李大严[1] 

机构地区：[1]海南省海口市人民医院妇产科,570208

出　　处：《中国医药》2014年第3期385-387,共3页China Medicine

基　　金：海南省卫生厅科研立项课题（琼卫2010-82）

摘　　要：目的 比较5种止血手术治疗难治性产后出血的效果,分析止血失败的原因.方法 回顾性分析海南省海口市人民医院2009年7月至2013年5月105例难治性产后出血患者的临床资料.将所有患者根据实施不同的止血手术分为宫腔填塞组（37例）、压迫缝合组（28例）、联合组（15例）、血管结扎组（13组）和动脉栓塞组（12例）.对比5组患者的术前出血量、术中出血量、总出血量、手术时间、输红细胞悬液、止血成功率、子宫切除率、转ICU率,并分析止血失败的原因.结果 动脉栓塞组及压迫缝合组的术中出血量明显少于血管结扎组[（260±90）、（454±79）ml比（1 101±122）ml],差异有统计学意义（均P＜0.05）.动脉栓塞组手术时间明显短于压迫缝合组、联合组、血管结扎组和动脉栓塞组[（58±10）min比（84±17）、（92±11）、（105±22）、（120±21）min],差异有统计学意义（P＜0.05）.动脉栓塞组止血成功率与子宫切除率与其他组比较[止血成功率：100.0%（12/12）比70.3%（26/37）、78.6%（22/28）、80.0%（12/15）、76.9%（10/13）;子宫切除率：0%（0/12）比29.7%（11/37）、21.4%（6/28）、20.0%（3/15）、23.1%（3/13）],差异均有统计学意义（P＜0.05）.止血失败的原因有患者为初产妇、产妇年龄高于35岁、多胎妊娠、瘢痕子宫、胎盘植入、前置胎盘、动脉栓塞治疗、剖宫产分娩、凝血功能障碍.其中,瘢痕子宫（OR=3.04,95%CI：1.05~7.54）、胎盘植入（OR=18.04,95%CI：5.72~57.93）、凝血功能障碍（OR=16.76,95%CI：3.34~82.96）是止血失败原因的高危因素.结论 宫腔填塞、压迫缝合、宫腔填塞联合压迫缝合、血管结扎、动脉栓塞5种止血方法均有不错的止血效果,但是介入治疗的成功率相对较高.影响止血失败的高危因素有胎盘植入、瘢痕子宫等,临床应该对症选择合适的止血方法,积极干预.Objective To discuss the effect comparison on five hemostasis surgeries in the treatment of intractable postpartum hemorrhage and reason analysis of homeostasis failure. Methods The clinical data of 105 patients with intractable postpartum hemorrhage in the People＆#39;s Hospital of Haikou City from July 2009 to May 2013 were retrospectively analyzed. All patients were divided into uterine packing group （37 cases）, oppression suture group （28 cases）, combined group （15 cases）, vascular ligation group （13 cases） and arterial embolism group （12 cases）. Preoperative blood loss, intraoperatve blood soss, the total blood loss, time of operation, red cells transfusion, success rate of hemostasis, the rate of uterus resection, intensive care unit （ICU） admission rate of five groups were compared, and the reasons for homeostasis failure were analyzed. Results Intraoperatve blood soss of arterial embolism group and oppression suture group were less than that of vascular ligation group [（260±90）,（454±79）ml vs （1 101±122）ml], there were significant differences （P〈0.05）. Time of operation of vascular ligation group was shorter than that of the other groups [（84±17）,（92±11）,（105±22）,（120±21）min vs （58±10）min], there were significant differences （P〈0.05）. There were significant differences on success rate of hemostasis and the rate of uterus resection in arterial embolism group compared with the other groups [success hemostasis：70.3%（26/37）, 78.6%（22/28）, 80.0%（12/15）, 76.9%（10/13） vs 100.0%（12/12）; uterus resection：29.7%（11/37）, 21.4%（6/28）, 20.0%（3/15）, 23.1%（3/13） vs 0%（0/12）] （P〈0.05）. There were some reasons of homeostasis failure such as patients of first-time mothers, age above 35 years old, multiple pregnancy, scarred uterus, placenta implantation, placenta previa, uterine rteril boliztion, cesarean delivery and coagulation disorders. Scarred uterus （OR=3.04, 95%CI：1.05-7.54）, placenta im

关 键 词：难治性产后出血 止血手术 失败原因 

分 类 号：R714[医药卫生—妇产科学]