宫缩乏力性产后出血治疗方法研究进展  

Research progress on the treatment methods for postpartum hemorrhage caused by uterine atony

作　　者：于梅花 YU Mei-hua(Obstetric Department,Tianjin Beichen District Xiaodian Community Health Service Center,Tianjin 300402,China)

机构地区：[1]天津市北辰区小淀社区卫生服务中心产科,天津300402

出　　处：《中国城乡企业卫生》2024年第1期34-37,共4页Chinese Journal of Urban and Rural Enterprise Hygiene

摘　　要：产后出血是孕产妇死亡的一个重要原因,产后出血原因多为宫缩乏力引起的,因此及时对宫缩乏力进行预见及处理非常重要,其可降低孕产妇死亡及严重并发症的发生,宫缩乏力性产后出血可采用药物治疗(催产素与卡贝缩宫素、麦角生物碱、前列腺素类制剂、脑垂体后叶素及益母草)、宫腔纱条填塞、补液、输血、手法按摩、宫腔球囊填塞、BLynch缝合、盆腔血管结扎术、经导管动脉栓塞术、子宫切除术等方法,其治疗需遵循“先无创,后有创”的原则。宫缩乏力性产后出血使用一线促宫缩药物配合按摩,若收缩欠佳可加用药物治疗。抢救时需各科协同治疗,多学科合作,同时建立静脉通路,及时为患者提供血制品,合理补液,若条件允许,可通过孕期自体血储备后回输。若患者生命体征稳定,可根据情况使用宫腔球囊填塞、宫腔纱条填塞、盆腔血管结扎术、B-Lynch缝合等保守治疗,同时对患者病情进行评估,把握子宫切除时机,不能一味追求保留子宫,从而丧失救治机会。本文对宫缩乏力性产后出血治疗方法研究进展进行综述,以期为宫缩乏力性产后出血患者的临床治疗提供参考。Postpartum hemorrhage is an important cause of maternal mortality.The postpartum hemorrhage are mainly caused by uterine atony.Therefore,it is very important to anticipate and deal with uterine atony in time,which can reduce the incidence of maternal death and serious complications.Postpartum hemorrhage caused by uterine atony can be treated with drug therapy(oxytocin and carketocin,ergot alkaloids,prostaglandins agents,pituitrin and motherwort),intrauterine gauze tamponade,rehydration,blood transfusions,massage,uterine balloon tamponade,B-Lynch suture,pelvic vein ligation,transcatheter arterial embolization,hysterectomy and other methods.The treatment should follow the principle of"non-invasive first,invasive later".Postpartum hemorrhage caused by uterine atony use firstline contraction-promoting drugs with massage,if the contraction is not good enough,it can be added with drug treatment.During rescue,collaborative treatment among various departments and multidisciplinary cooperation should be carried out.At the same time,venous access should be established,blood products should be provided to patients in time,and fluids should be replenished reasonably.If conditions permit,autologous blood can be stored during pregnancy and then retransfusion can be carried out.If the patient's vital signs are stable,intra uterine balloon tamponade,intrauterine gauze tamponade,pelvic vascular ligation,B-Lynch suture and other conservative treatments can be used according to the situation.Meanwhile,the patient's condition is evaluated and the timing of hysterectomy is grasped,instead of blindly trying to preserve the uterus and lose the opportunity of treatment.This article reviews the research progress of treatment methods for postpartum hemorrhage caused by uterine atony,in order to provide reference for the clinical treatment of patients with postpartum hemorrhage caused by uterine atony.

关 键 词：宫缩乏力性产后出血 治疗方法 药物治疗 宫腔填塞 B-LYNCH缝合 

分 类 号：R714.46[医药卫生—妇产科学]