宫腔止血囊用于非前置胎盘剖宫产产后出血的止血效果分析  

Intrauterine Balloon Tamponade in the Management of Postpartum Haemorrhage after Caesarean Section in Women with Normal Placental Position

作　　者：戴毅敏[1] 顾宁[1] 周燕 胡娅莉[1] 王志群[1] 刘柳柳 刘琦 肖镇冬[1] DAI Yimin;GU Ning;ZHOU Yan(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing Jiangsu 210008,China)

机构地区：[1]南京鼓楼医院妇产科,江苏南京210008

出　　处：《实用妇产科杂志》2021年第4期281-286,共6页Journal of Practical Obstetrics and Gynecology

基　　金：江苏省十三五科技强卫工程(编号:YXZXB2016004);南京市产科临床中心建设项目(编号:[2014]9号)。

摘　　要：目的:研究非前置胎盘剖宫产产后出血(PPH)的产妇中,宫腔止血囊填塞的安全性和有效性,分析影响填塞止血失败的风险因素。方法:回顾性分析2013年1月至2019年12月在南京鼓楼医院非前置胎盘剖宫产产后接受专用宫腔止血囊填塞止血的产妇资料。止血囊填塞后不需要追加其他止血措施者为填塞成功组,需要额外措施者为失败组。根据填塞时机的不同,还分为剖宫产术中经腹填塞组、下台经阴道填塞组以及回室后经阴道填塞组。比较各组填塞前后围术期管理和孕产妇并发症情况,建立多元回归模型分析影响止血失败的因素。结果:共纳入93例孕妇,其中成功组共81例(87.1%),失败组12例(12.9%)。导致PPH的原因均以宫缩乏力为主,失败组凝血功能障碍者的比例显著高于成功组,差异有统计学意义(P<0.05)。术中经腹组、下台经阴道组和回室后经阴道组填塞止血囊者分别为48例(51.6%),23例(24.7%)和22例(23.7%),其中回室后经阴道组填塞止血囊前的出血量显著高于术中经腹组和下台经阴道组,但回室后经阴道组24小时总失血量高于术中经腹组,差异有统计学意义(P<0.05)。失败组的填塞前B-Lynch缝合率、估计失血量>1500 ml的比例均高于成功组,而成功组宫腔填塞持续时间显著长于失败组,差异均有统计学意义(P<0.05)。失败组均需要输注红细胞,红细胞输注≥4 U的比例显著高于成功组;同时,失败组24小时平均失血量、接受子宫血管栓塞、子宫切除和入住重症监护病房的比例也显著高于成功组,差异有统计学意义(P<0.05)。Logistic多元回归分析显示,填塞前出血>1500 ml者宫腔填塞失败风险显著增加(OR 5.250,95%CI 1.101~25.042,P=0.038)。结论:宫腔止血囊用于非前置胎盘剖宫产产后出血的止血,具有较高的成功率,填塞前出血>1500 ml者止血失败率显著增加,应早期、规范填塞。Objective:To evaluate the effectiveness and safety of the uterine balloon tamponade in the management of postpartum haemorrhage after caesarean section in women with normal placental position.To identify the factors predicting tamponade failure.Methods:This retrospective study was conducted in Nanjing Drum Tower Hospital.Women without placenta previa who underwent balloon tamponade during or after caesarean section between 2013 and 2019 were enrolled.Women who obtained bleeding arrests by avoiding second line surgeries were defined as the success group.Those who need second line surgeries were defined as the failure group.Based on the timing of tamponade, women were grouped into transabdominal insertion during operation, transvaginal insertion after operation or transvaginal insertion when back in ward.The perioperative management and maternal complications before and after tamponade in each group were compared, and multiple regression model was established to analyze the factors influencing haemostasis failure.Results:A total of 93 pregnant women were included, including 81 cases(87.1%) in the successful haemostasis group and 12 cases(12.9%) in the failure group.The main cause of PPH was uterine atony.The proportion of coagulation dysfunction in failure group was significantly higher than that in success group(P<0.05).The women who need balloon insertion transabdominal during operation, or transvaginal insertion after operation or transvaginal insertion when back in ward were 48 cases(51.6%),23 cases(24.7%)and 22 cases(23.7%) respectively.Among them, the amount of bleeding in the transvaginal insertion when back in ward group was significantly higher than that in the transabdominal during operation group and transvaginal insertion after operation group, but the 24 h total blood loss in transvaginal insertion when back in ward group was higher than that in the transabdominal during operation group, the difference was statistically significant(P<0.05).Before tamponade, the rate of B-Lynch suture and the rate of es

关 键 词：宫腔填塞 宫腔止血囊 产后出血 剖宫产 宫缩乏力 

分 类 号：R714.461[医药卫生—妇产科学]