Surgical Treatment of 108 Cases of Refractory Postpartum Hemorrhage
-
摘要:
目的 探究在欠发达地区医院应用B-lynch缝合术加宫腔纱条填塞术治疗难治性产后出血的临床价值。 方法 收集昭通市第一人民医院2015年5月至2017年10月收治的108例难治性产后出血患者做对比研究，将治疗方案作为分组依据，按随机数字表法将其分为：B-lynch缝合术加宫腔纱条填塞术组（A）58例，其他方案治疗组（B）50例，对照两组的手术时间、出血量、输血量、住院时间、止血效果、子宫保留及近远期并发症。 结果 A组术中出血量及输血量均明显低于B组，手术用时长于B组，两组差异有统计学意义（P < 0.05）。A组58例均有效止血，占100%，无子宫切除病例，无严重术后并发症；B组43例有效止血，占86%，7例继发宫缩乏力再次出血行子宫切除术，占14%，无严重术后并发症，A、B两组止血均明显有效；A组有效止血率较B组高而子宫切除率较B组低，两组比较，差异有统计学意义（P < 0.05）。 结论 B-lynch缝合术加宫腔纱条填塞术不仅操作简便、止血迅速有效，还能尽量保留子宫，在医疗条件欠发达地区医院是治疗难治性产后出血的有效措施，值得推广应用。 -
关键词:
- 难治性产后出血 /
- B-lynch缝合术 /
- 宫腔纱条填塞术
Abstract:Objective To explore the clinical value of B-lynch suture combined with intrauterine gauze packing in the treatment of refractory postpartum hemorrhage in hospitals in underdeveloped areas. Methods A comparative study was conducted on 108 cases of refractory postpartum hemorrhage admitted by the first people's hospital of zhaotong city from May 2015 to October 2017. The treatment regimen was used as a basis for grouping, 108 cases were divided into: （A） 58 cases of B-lynch suture plus intrauterine gauze packing, and （B） 50 cases of other treatment groups. The operation time, blood loss, amount of blood transfusion, length of hospital stay, hemostatic effect, uterine retention and complications were compared. Results The intraoperative blood loss and blood transfusion amount in group A were significantly lower than that in group B, and the operation time was longer than that in group B, and the difference between the two groups was statistically significant （P < 0.05）. All the 58 cases in group A were effective in hemostasis, accounting for 100%, without hysterectomy and serious postoperative complications. In group B, 43 patients were effective in hemostasis, accounting for 86%, and 7 patients were treated with hysterectomy for secondary uterine weakness and bleeding again, accounting for 14%, without serious postoperative complications. Hemostasis in both group A and group B was significantly effective. The effective hemostasis rate of group A was higher than that of group B, while the uterine excision rate was lower than that of group B. There was significant difference between the two groups （P < 0.05）, showing statistical significance. Conclusions B-lynch suture plus intrauterine gauze packing is not only simple and effective in operation, quick and effective in hemostasis, but also can keep the uterus as far as possible. It is an effective measure to treat refractory postpartum hemorrhage in hospitals in underdeveloped areas, and is worthy of popularization and application. -
表 1 一般情况对比（
$\bar x \pm s $ ）Table 1. Comparison of the general data （
$\bar x \pm s $ ）A组（n = 58） B组（n = 50） t/χ2 P 年龄（岁） 26.76 ± 2.867 27.10 ± 2.757 0.628 0.531 孕周（周） 38.29 ± 1.357 38.00 ± 1.314 1.137 0.258 孕次（次） 3.12 ± 1.612 2.98 ± 1.597 0.454 0.651 产次（次） 2.28 ± 0.914 2.16 ± 0.934 0.651 0.517 前置胎盘（n） 23 20 0.001 0.971 凶险性前置胎盘（n） 11 7 0.477 0.490 产程异常（n ） 6 5 0.003 0.953 双胎（n） 6 4 0.176 0.675 妊娠期高血压疾病（n） 4 5 0.339 0.561 胎盘严重粘连（n） 5 3 0.269 0.604 胎盘早剥（n） 3 2 0.084 0.773 巨大儿（n） 2 2 0.023 0.878 
下载: 导出CSV
表 2 两组手术情况及近远期并发症情况（
$\bar x \pm s $ ）Table 2. Comparison of the operation condition and short-term and long-term complications between two groups （
$\bar x \pm s $ ）观察指标 A组（n = 58） B组（n = 50） t/χ2 P 手术时间（min） 89.43 ± 10.22 80.92 ± 10.07 4.343 < 0.001 出血量（mL） 1743.00 ± 165.80 2119.00 ± 506.10 5.335 < 0.001 输血量（mL） 314.70 ± 206.90 710.00 ± 579.20 4.854 < 0.001 住院时间（d） 6.29 ± 1.09 7.56 ± 1.31 5.476 < 0.001 子宫切除（n） 0 7 8.683 0.003 晚期产后出血（n） 0 1 1.171 0.279 产褥感染（n） 2 1 0.209 0.648
下载: 导出CSV
-
[1] 谢幸, 苟文丽. 妇产科学[M]. 第8版, 北京: 人民卫生出版社, 2013: 30. [2] 中华医学会妇产科学分会产科学组. 产后出血预防与处理指南 (2014)[J]. 中华妇产科杂志,2014,9 (49):641-645. [3] 田宏,张明,陈惠池,等. 孕产妇死亡研究现状[J]. 中国实用妇科与产科杂志,2004,20(6):379-380. doi: 10.3969/j.issn.1005-2216.2004.06.026 [4] 梁朝霞,陈丹青. 产后出血的高危因素和流行病学新特点[J]. 实用妇产科杂志,2012,28(11):897-899. doi: 10.3969/j.issn.1003-6946.2012.11.001 [5] 王辉. 产后出血的诊断与治疗[J]. 临床医药文献杂志,2017,4(54):10547. [6] WorldHealthOrganization. WHO guidelines for the management of postpartum haemorrhage and retained placenta [DB/OL]. http://www.who.int/reporductivehealth/publications/maternal.pernatal-health/9789241598514/en./2009: 1-60. [7] 王红霞. 水囊压迫与纱布填塞治疗剖宫产术中大出血疗效比较[J]. 中国实用妇科与产科杂志,2008,24(2):139-140. doi: 10.3969/j.issn.1005-2216.2008.02.019 [8] 朱丽秋. 子宫填塞球囊导管治疗产后出血的效果研究[J]. 中国继续教育医学,2015,7(11):65-66. [9] 曾玉华,周洪贵,李佳平,等. 改良式B-Lynch 缝合术在剖宫产产后出血中的运用[J]. 实用妇产科杂志,2011,27 (4):312-313. doi: 10.3969/j.issn.1003-6946.2011.04.028 [10] Jean Dit Gautier E,Midulla M,Lucot J P,et al. Hyperbaric oxygen therapy in a case of vaginal and uterine necrosis after embolization for postpartum hemorrhage[J]. Int J Gynecol Obstet,2015,130(3):286-287. doi: 10.1016/j.ijgo.2015.03.034 [11] Tang H Y,Wang Y. Misoprostol combined with oxytocin toprvent postpartum hemorrhage[J]. China J Modem Med,2015,25(1):96-97. [12] 蔺雪晴,杨艳. 产后出血的治疗进展[J]. 检验医学与临床,2011,8 (3):330-332. doi: 10.3969/j.issn.1672-9455.2011.03.042 [13] 张扬. 手术治疗产后出血新进展[J]. 中国现代药物应用,2011,5(2):239-240. doi: 10.3969/j.issn.1673-9523.2011.02.222 [14] 应豪. 子宫压迫缝合术:过去、现在和将来[J]. 国际妇产科学杂志,2011,38(5):375-377. doi: 10.3969/j.issn.1674-1870.2011.05.001 [15] Ying H,Duan T,Bao Y R,et al. Transverseannularcompression sutures in the lower utrine segment to control postpartum hemorrhage atcesarean delivery for complete placenta previa[J]. Int J Gynecol Obstet,2010,108(3):247-248. doi: 10.1016/j.ijgo.2009.10.006 [16] 周萍. 子宫背带式缝合术在剖宫产术中大出血的应用[J]. 当代医学,2011,17(18):80. doi: 10.3969/j.issn.1009-4393.2011.18.055 [17] 庄憬怡,应豪. 产后出血手术治疗的评价[J]. 实用妇产科杂志,2012,28(11):905-907. doi: 10.3969/j.issn.1003-6946.2012.11.004 [18] 郝敏,王志莲. 髂内动脉结扎在晚期产后出血中的应用价值[J]. 中国实用妇科与产科杂志,2001,17(2):76-78. doi: 10.3969/j.issn.1005-2216.2001.02.009 [19] 杨九红. B-Lynch缝合术联合双侧子宫动脉结扎治疗前置胎盘产后出血的效果观察[J]. 河南外科学杂志,2017,23(5):143-144. [20] 许海燕. 冰盐水冷敷联合动脉上行支结扎和子宫背带缝合术治疗难治性产后出血的效果观察[J]. 中国医药指南,2017,15(27):86-87. [21] 黄瑾,方玲,沈卓娜,等. 难治性产后出血干预性治疗方法的对比研究[J]. 中国实用妇科与产科杂志,2004,20(6):343-345. doi: 10.3969/j.issn.1005-2216.2004.06.011 [22] 周淼. 背带式子宫缝合联合水囊压迫治疗剖宫产中难治性产后出血的疗效观察[J]. 中国妇幼保健,2017,32(17):4302-4304. -
