前置胎盘剖宫产改良术式预防产后出血的探讨  

Efficacy of improved cesarean section of placenta previa in preventing postpartum hemorrhage

作　　者：唐䶮 唐卉[1] 陈悦[1] 李慕军[1] Tang Yan;Tang Hui;Chen Yue;Li Mujun(Department of Obstetrics and Gynecology,the First Affliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院妇产科,南宁530021

出　　处：《中华临床医师杂志(电子版)》2022年第5期436-441,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：广西壮族自治区卫生厅自筹经费科研课题(Z2013096)。

摘　　要：目的探讨在避免宫腔内操作的基础上尽早缝合子宫切口的术式在前置胎盘剖宫产中应用的安全性和有效性。方法选取2014至2019年在广西医科大学第一附属医院进行剖宫产的158例前置胎盘产妇作为研究对象,根据随机数字表法将其分为两组,研究组79例均行改良式剖宫产术治疗,对照组79例均行常规剖宫产术式治疗。观察比较两组手术情况(手术时间、术后24 h的外周血血红蛋白减少量、产后出血构成比、输血构成比、输红细胞悬液量、术后住院时间),以及术后并发症发生情况(腹壁切口愈合不良、子宫内膜炎)等。结果研究组年龄为(35.0±5.4)岁,对照组为(34.0±4.3)岁,差异无统计学意义(P>0.05)。研究组的手术时间为(48.85±13.80)min、产后出血率(6.3%)、术后住院时间(4.30±0.79)d显著低于对照组[分别为(67.27±20.87)min、17.7%、(4.71±1.28)d],差异均有统计学意义(均P<0.05)。两组产妇术前外周血红细胞、血红蛋白水平间差异无统计学意义(均P>0.05),术后24 h外周血红细胞、血红蛋白水平均较术前降低,但研究组降低幅度(12.07±7.85)g/L小于对照组的(15.54±8.86)g/L,且差异有统计学意义(P<0.05)。研究组输血构成比、输红细胞悬液量、术后并发症发生率稍低于对照组,但差异无统计学意义(均P>0.05)。结论前置胎盘剖宫产术中在避免宫腔内操作的基础上尽早缝合子宫切口可有效减少术中出血,且安全可靠,简单易学,值得在临床广泛开展。Objective To explore the safety and effectiveness of early suture of uterine incision on the basis of avoiding intrauterine operation in cesarean section of placenta previa.Methods A total of 158 pregnant women with placenta previa who underwent cesarean section at the First Affliated Hospital of Guangxi Medical University from 2014 to 2019 were selected as the research subjects.The patients were divided into either a study group(n=74)or a control group(n=79)according to the random number table method;the study group was treated by modified cesarean section and the control group was treated with conventional cesarean section.The operation parameters(operation time,reduction of peripheral blood hemoglobin 24 hours after operation,incidence of postpartum hemorrhage,blood transfusion ratio,amount of red blood cell suspension transfused,and postoperative hospital stay)and postoperative complications(poor healing of abdominal incision and intrauterine infection)were observed and compared between the two groups.Results The mean age of patients in the study group was(35.0±5.4)years,and it was(34.0±4.3)years in the control group;there was no significant differences between the two groups(P>0.05).The operation time,the incidence of postpartum hemorrhage,and postoperative hospital stay in the study group were all significantly lower than those in the control group[(48.85±13.80)min vs(67.27±20.87)min,6.3%vs 17.7%,and(4.30±0.79)d vs(4.71±1.28)d,respectively;P<0.05].There was no significant difference in the level of peripheral blood erythrocytes or hemoglobin between the two groups before operation(both P>0.05).The levels of peripheral blood erythrocytes and hemoglobin at 24 hours after operation were lower than those before operation,but the reduction in the study group was less than that in the control group[(12.07±7.85)g/L vs(15.54±8.86)g/L,P<0.05].The transfusion ratio,the amount of red blood cell suspension transfused,and the incidence of postoperative complications in the study group were all slightly lower tha

关 键 词：前置胎盘 剖宫产术 产后出血 改良术式 

分 类 号：R719.8[医药卫生—妇产科学]