难治性产后出血的原因及治疗方法比较  

Comparison of risk factors and treatments of intractable postpartum hemorrhage

作　　者：于周[1] 唐素春[1] 李兢[1] 王海荣[1] 

机构地区：[1]南京医科大学附属淮安市第一人民医院产科,南京江苏223300

出　　处：《中国妇幼健康研究》2016年第11期1378-1381,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨难治性产后出血的可能高危因素及各种处理方法的临床效果。方法采用回顾性分析方法,选取淮安市第一人民医院妇产科2011-2015年分娩并诊断为产后难治性出血的120例产妇(难治性出血组),按照1:1选取同期非难治性出血产妇120例作为对照组,统计分析两组一般临床资料的差异,探讨可能诱发产后难治性出血的高危因素,并分析各种处理方法的处理效果。结果难治性出血组的宫缩乏力(65.00%)、产妇高龄(26.67%)、经产妇所占比例(62.50%)、既往人流史所占比例(43.33%),均显著高于对照组,且差异均具有统计学意义(χ2值分别为4.389、14.797、9.624、18.919,均P<0.05);宫腔填塞纱条或球囊28例、盆腔动脉栓塞18例、子宫动脉结扎17例、改良Blynch缝合法34例、子宫动脉结扎+改良Blynch缝合23例,各组患者术前出血量差异均无统计学意义(F=1.094,P>0.05),改良Blynch缝合、子宫动脉结扎+改良Blynch缝合法患者的术后出血量显著低于宫腔填塞纱条或球囊、盆腔动脉栓塞、子宫动脉结扎处理的患者(t值分别为3.194、2.781、3.601、2.295、2.338、2.267,均P<0.05),子宫动脉结扎处理患者的术后出血量显著低于宫腔填塞纱条或球囊、盆腔动脉栓塞(t值分别为2.816、2.339,均P<0.05);宫腔填塞纱条或球囊、改良Blynch缝合、子宫动脉结扎+改良Blynch缝合的止血成功率分别为82.14%、82.36%、86.69%,均显著高于子宫动脉结扎患者(χ2值分别为4.194、4.338、4.205,均P<0.05)。Logistic回归分析结果显示宫缩乏力(OR=1.817)、产妇高龄(OR=1.396)、初产妇(OR=1.504)是发生难治性产后出血的危险因素。结论宫缩乏力、产妇高龄、分娩史、既往人流史是产后出血并发难治性产后出血的高危因素;综合考虑术后出血量和止血成功率,子宫动脉结扎+改良Blynch缝合对于难治性产后出血的止血效果较为良好。Objective To explore the possible high risk factors and clinical effect of various therapies for intractable postpartum hemorrhage .Methods Totally 120 puerperae with intractable postpartum hemorrhage of delivery from 2011 to 2015 were selected （ intractable hemorrhage group ） in the First People ’ s Hospital of Huai＆#39;an City Affiliated to Nanjing Medical University , while 120 puerperae were selected in same period to control group within the ratio of 1：1.The clinical data were analyzed retrospectively .The difference in general clinical data between two groups were statistically analyzed to explore the possible risk factors of intractable postpartum hemorrhage and analyze the clinical effect of various therapies .Results The proportion of puerperae with uterine inertia （65.00%）, advanced maternal age （26.67%）, multipara （62.50%）, past aborted history （43.33%） in intractable hemorrhage group was significantly higher than that of the control group .The differences were statistically significant （χ2 value was 4.389, 14.797, 9.624 and 18.919, respectively, all P〈0.05）.In the intractable hemorrhage group , 28 cases were treated with gauze packing in uterine cavity , 18 cases were treated by pelvic arterial embolization , 17 cases were treated with uterine artery ligation , 34 cases were treated with improved Blynch suture , and 23 cases were treated with uterine artery ligation combined with improved Blynch suture .There was no significant difference in hemorrhage between two groups （F=1.094, P〉0.05）.The postoperative hemorrhage of patients accepting improved Blynch suture and uterine artery ligation combined with improved Blynch suture was significantly lower than that of patients accepting gauze packing in uterine cavity, pelvic arterial embolization and uterine artery ligation （t value was 3.194, 2.781, 3.601, 2.295, 2.338 and 2.267, respectively, all P〈0.05）.The postoperative hemorrhage of patients accepting uterine artery ligation was significantly lower than that

关 键 词：难治性产后出血 高危因素 宫缩乏力 高危因素 

分 类 号：R714.461[医药卫生—妇产科学]