难治性产后出血围产期急症子宫切除术19例临床分析  

Clinical analysis of 19 cases of emergent peripartum hysterectomy in refractory postpartum hemorrhage

作　　者：陈蕾[1] 揣云海 高金芳 包迎来 夏松云 CHEN Lei;CHUAI Yunhai;GAO Jin fang;BAO Yinglai;XIA Songyun(Department of Obstetrics and Gynecology,Sixth Medical Center,General Hospital of Chinese PLA,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心妇产科,北京市高危孕产妇转诊中心,北京100048

出　　处：《中国妇产科临床杂志》2021年第2期159-161,共3页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：全军计生重点专项(20JSZ14)。

摘　　要：目的探讨难治性产后出血围产期急症子宫切除术的原因、时机、术后并发症及孕产妇结局。方法回顾性分析2016年7月至2019年12月本院收治的因难治性产后出血行急诊子宫切除术19例患者的临床资料。结果 19例患者平均年龄(33.4±4.2)岁,平均孕次(2.8±1.2)次,平均孕周(36.4±4.4)周。子宫切除术原因为胎盘因素7例,宫缩乏力为5例,宫缩乏力合并边缘性胎盘产前出血2例,软产道损伤形成大血肿2例,羊水栓塞2例,晚期产后出血合并感染1例。子宫切除术前平均出血量(4 697.2±1 868.5)ml,平均血红蛋白(56.3±21.7)g/L。除1例羊水栓塞患者死亡外,18例患者痊愈出院。结论围产期急症子宫切除是治疗难治性产后出血的重要措施,胎盘异常及宫缩乏力是两大主要原因。Objectives To investigate the causes, timing, postoperative complications and maternal outcomes of emergent peripartum hysterectomy(EPH) with refractory postpartum hemorrhage. Methods Retrospective analysis was performed on the clinical data of 19 patients who underwent EPH due to refractory postpartum hemorrhage admitted to our hospital from July 2016 to December 2019. Results The average age of 19 cases was(33.4±4.2) years old, the average parity was(2.8±1.2) times,the average delivery gestational week was(36.4±4.4) weeks. The causes of EPH included placenta factors(7 cases), uterineatony(5 cases), uterine atony with placenta factors(2 cases), genital tract laceration with large hematoma(2 cases), amniotic fluid embolism(2 cases) and late postpartum hemorrhage with endometritis(1 cases). Average amount of bleeding before hysterectomy was(4 697.2± 1 868.5) ml. The average hemoglobin was(56.3±21.7) g/L. 18 patients were recovered except one case died of amniotic fluid embolism. Conclusion EPH is an important measure for the treatment of refractory postpartum hemorrhage, placental factors and uterine contractions are the two main causes.

关 键 词：难治性产后出血 急症子宫全切术 围产期 预后 

分 类 号：R714.461[医药卫生—妇产科学] R714.42[医药卫生—临床医学]