41例产后出血子宫切除术后的影响因素  

Analysis of 41 Cases of Hysterectomy Resulting from Postpartum Hemorrhage

作　　者：刘娟娟 张春莲[2] 赵琳[2] 蒲晓丽 汤文静 Liu Juanjuan;Zhang Chunlian;Zhao Lin;Pu Xiaoli;Tang Wenjing(Postgraduate Training Basement of Shiyan Taihe Hospital,Jinzhou Medical University;Department of Obstetrics and Gynecology,Taihe Hospital,Shiyan 442000 China)

机构地区：[1]锦州医科大学十堰市太和医院研究生培养基地 [2]十堰市太和医院妇产中心妇产科,湖北十堰442000

出　　处：《锦州医科大学学报》2021年第3期70-74,共5页Journal of Jinzhou Medical University

基　　金：湖北省卫健委项目,项目编号:WJ2019F056。

摘　　要：目的通过对十堰市太和医院产后出血子宫切除孕产妇进行资料分析,研究产后出血子宫切除的高危因素及原因,为妊娠管理提供指导。方法回顾性研究该院2012年1月1日至2019年12月31日因产后出血子宫切除的孕产妇共41例,分析其临床特点、高危因素及原因。结果该院产科8年间总分娩数为22802例,其中经阴道分娩数为8098(35.51%)例,剖宫产分娩数14704(64.49%)例,该院产科子宫切除率为0.179%(41/22802),阴道分娩子宫切除率0.061%(5/8098),剖宫产子宫切除率0.245%(36/14704),不同分娩方式相比子宫切除率差异有统计学意义(P<0.05);胎盘因素是产后出血子宫切除最主要原因,占56.1%(凶险性前置胎盘占22%,胎盘植入34.1%),其次为子宫收缩乏力占22%,弥散性血管内凝血(DIC)占12.2%,软产道裂伤占7.3%,羊水栓塞占2.4%。结论子宫切除术是挽救产后出血孕产妇生命一项重要措施,慎重选择分娩方式、减少异常胎盘发生率能降低子宫切除的发生。Objective To study the risk factors and causes of hysterectomy for postpartum hemorrhage by analyzing the data of pregnant women in our hospital who underwent hysterectomy because of postpartum hemorrhage,so as to provide guidance for pregnancy management.Methods A total of 41 cases of pregnant women who underwent hysterectomy due to postpartum hemorrhage in our hospital from January 1,2012 to December 31,2019 were retrospectively studied,and their clinical characteristics,high-risk factors and causes were analyzed.Results During the last 8 years,the total number of deliveries in Department of Obstetrics of our hospital was 22802 cases,including 8098 cases of vaginal delivery(35.51%)and 14704 cases of cesarean delivery(64.49%).The hysterectomy rate in our hospital was 0.179%(41/22802),that after vaginal delivery was 0.061%(5/8098),and that after cesarean section was 0.245%(36/14704).The difference of hysterectomy rate between different delivery modes was statistically significant(P<0.05).Placental factors were the main causes of hysterectomy for postpartum hemorrhage,accounting for 56.1%(dangerous placenta praevia accounting for 22%and placental implantation for 34.1%),followed by uterine atony accounting for 22%,disseminated intravascular coagulation(DIC)for 12.2%,soft birth canal lacerations for 7.3%,and amniotic fluid embolism for 2.4%.Conclusion Hysterectomy is an important measure to save the lives of pregnant women with postpartum hemorrhage.Careful choice of delivery mode and reduction of the incidence of abnormal placenta can reduce the incidence of hysterectomy.

关 键 词：产后出血 紧急围产期子宫切除术 胎盘植入 剖宫产 因素分析 

分 类 号：R713.4[医药卫生—妇产科学]