Bakri止血球囊治疗产后出血的有效性和安全性  

Efficacy and safety of intrauterine Bakri balloon tamponade in the treatment of postpartum hemorrhage： a multicenter analysis of 109 cases

作　　者：高羽[1] 王子莲[2] 张建平 王冬昱[2] 尹保民[5] 朱斌 何艳君[7] 侯红瑛 曹伍兰[8] 刘晓瑛 余艳萍 潘石蕾[11] 刘力华[13] 王志坚 苏放明[14] 

机构地区：[1]中山大学附属第六医院妇产科,广州510655 [2]中山大学附属第一医院妇产科,广州510080 [3]附属孙逸仙纪念医院妇产科,广州510080 [4]附属第三医院妇产科,广州510080 [5]广东省珠海市妇幼保健院产科,广州510080 [6]广州市番禺区何贤纪念医院妇产科,广州510080 [7]广东省中山市博爱医院妇产科,广州510080 [8]广东省中山市人民医院妇产科,广州510080 [9]深圳市罗湖区妇幼保健院产科,广州510080 [10]广东省中山市小榄医院妇产科,广州510080 [11]南方医科大学珠江医院妇产科,广州510080 [12]南方医院妇产科,广州510080 [13]深圳市妇幼保健院产科,广州510080 [14]深圳市人民医院妇产科,广州510080

出　　处：《中华妇产科杂志》2014年第9期670-675,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨Bakri止血球囊（简称Bakri球囊）放置在治疗产后出血中的有效性和安全性。方法收集2013年4月至10月中山大学附属第一医院等广东地区13家医院、经一线治疗方法治疗无效的产后出血孕妇109例，放置Bakri球囊治疗产后出血。分析产后出血的原因；放置Bakri球囊后出血明显减少，无需另外加用其他有创性止血方法为止血成功。记录放置Bakri球囊前、后阴道流血量，检测血红蛋白下降水平、分娩至放置球囊时间间隔、球囊放置途径及留置时间、球囊放置后并发症等。对放置Bakri球囊止血成功率进行分层分析。结果（1）109例患者产后24h阴道流血量平均1523ml，102例患者放置Bakri球囊后成功止血（成功组），7例患者出血仍不能控制（失败组）。Bakri球囊止血的总成功率为93．6％（102／109），失败率为6．4％（7／109）。其中，剖宫产分娩患者的止血成功率为94％（93／99），阴道分娩患者的止血成功率为9／10。前置胎盘、胎盘植入、瘢痕子宫作为高危因素的患者放置Bakri球囊后，其止血成功率分别为88％（45／51）、13／16、95％（19120），前两者略低于止血总成功率。（2）成功组放置Bakri球囊后的产后出血量（364m1）明显少于失败组（1533m1），两组比较，差异有统计学意义（P〈0．05）。两组患者的血红蛋白水平比较，差异无统计学意义（P〉0.05）。（3）109例患者中，经阴道放置Bakri球囊38例，其中36例成功止血，成功率为95％（36／38）；经剖宫产切口放置Bakri球囊7l例，其中66例成功止血，成功率为93％（66／71），两者比较，差异无统计学意义（P〉0.05）。成功组放置Bakri球囊的留置时间为（22．0＋3．0）h，失败组留置时间为（3．0±1．0）h，两组比较，差异有统计学意义（P〈0.05）。（4）109例患者中，Bakri球囊放置后无宫腔感染，产后42d超声随访Objective To evaluate the efficacy and safety of the Bakri balloon in the treatment of postpartum hemorrhage （PPH）. Methods A total of 109 patients with PPH who underwent Bakri balloon insertion after unsuccessful first-line medication from thirteen hospitals in Guangdong from Apr. 2013 to Oct. 2013 were recruited in this study. Bakri balloons were applied via vagina or abdomen depending on the delivery mode. The high risk factors and the causes of the PPH were analyzed. The bleeding volume of before and after placing Bakri balloon, the hemoglobin drop-out value, the interval time between the delivery and applying Bakri, the placement mode, staying time, and the complications were recorded. To stratified analyze the Bakri balloon hemostasis success rate and evaluate its safety. Results （1） The average amount of 24 hours PPH of all 109 cases was 1 523 ml. Successful hemostasis was achieved in 102 cases after Bakri balloon placement, defined as success group. In the other 7 cases, bleeding were not controlled, defined as failure group （six patients underwent hysterectomy）. The overall Bakri balloon hemostasis successful rate was 93.6% （102/109）, and the failure rate was 6.4% （7/109）. The successful rate in cesarean section group was 94% （93/99）, and in vaginal delivery group was 9/10. In the patients with placenta previa, placenta increta or scar uterus, the successful rate of Bakri balloon hemostasis was 88% （45/51）, 13/16 and 95% （19/20）, respectively, and were slightly below the overall successful rate. （2） Data showed that PPH volume after Bakri balloon placement was significantly lower in the success group （364 ml） than that in the failure group （1 533 ml, P〈0.05）. However, the hemoglobin drop-off value and the case number that need blood transfusion had no statistically significant difference （P〉0.05）. （3） The Bakri balloons were placed via vagina in 38 cases, and successful hemostasis was achieved in 36 cases, with the successful rate of 95%（36/38）.

关 键 词：产后出血 气囊阻塞 多中心研究 可重复性 结果 

分 类 号：R714.461[医药卫生—妇产科学]