剖宫产术中应用B-lynch缝合止血失败的原因分析  

Analysis of failure causes of hemostasis by B-Lynch suture during cesarean section

作　　者：黄乐[1] 杨微涛[1] 彭景[1] 倪萍[1] 陈秋玲[1] 周文娟 HUANG Le;YANG Weitao;PENG Jing;NI Ping;CHEN Qiuling;ZHOU Wenjuan(Changsha Maternal and Child Health Care Hospital,Hunan Province,410007)

机构地区：[1]湖南省长沙市妇幼保健院,410007

出　　处：《中国计划生育学杂志》2022年第4期922-926,共5页Chinese Journal of Family Planning

基　　金：2018年度长沙市科学技术局指导性科技计划项目(ZD1802013)。

摘　　要：目的:分析剖宫产术中应用B-Lynch缝合止血失败的原因,从而进一步减少剖宫产产后出血。方法:选取2016年1月-2021年1月在本院行剖宫产术,因宫缩乏力以B-Lynch缝合作为首选外科止血方法的112例患者作为研究对象,评价B-Lynch缝合的止血效果,分析其止血失败的原因及对策。结果:B-Lynch缝合止血失败的主要原因为子宫下段止血不到位、子宫体积大、肌壁厚导致子宫压迫不到位、胎盘剥离面止血不到位、术中出血速度快等;止血失败组(16例)中流产史、瘢痕子宫、胎盘异常比例均高于止血成功组(96例)(P<0.05),胎盘异常是影响止血效果的独立危险因素(OR=13.626,95%CI3.829~48.496)。结论:B-Lynch缝合止血有其局限性,需合理选择剖宫产术中外科止血方法,流产史、瘢痕子宫、胎盘异常是B-Lynch缝合止血失败的高危因素。Objective:To analyze the failure causes of hemostasis by B-Lynch suture during cesarean section,so as to further reduce postpartum hemorrhage after cesarean section.Methods:112women who underwent B-Lynch suture as the first surgical hemostatic method because of uterine inertia during cesarean section from January 2016to January 2021were selected as the research object.The hemostatic effect of B-Lynch suture was evaluated,and the causes of hemostatic failure and its countermeasures were analyzed.Results:The main reasons of the hemostasis failure by BLynch suture were incomplete hemostasis in lower uterine segment and placental site,large uterine volume,inadequate compression due to uterine thick muscle wall,and intraoperative bleeding rapidly,etc.The proportions of abortion history,scar uterus,and abnormal placenta of the women with failed hemostasis(16cases)was significantly higher than that of the women(96cases)with successful hemostasis(P<0.05).Abnormal placenta was an independent risk factor affecting hemostasis effectiveness(OR=13.626,95%CI 3.829-48.496).Conclusion:B-Lynch suture used for hemostasis of the women during cesarean section has its limitations,so it is necessary to select the surgical hemostasis method reasonably.Abortion history,scar uterus,and placental abnormalities are the high-risk factors of B-Lynch suture hemostasis failure.

关 键 词：B-LYNCH缝合 剖宫产 产后出血 止血失败 

分 类 号：R719.8[医药卫生—妇产科学]