CAJ | 학술논문

目的：：探讨引起难治性产后出血的主要危险因素,并分析紧急子宫切除术的治疗效果。方法：2008年6月~2012年5月124例我院收治的难治性产后出血患者124例作为实验组,同期在我院住院的无产后出血产妇124例作为对照组,采用病例对照研究的方法对难治性产后出血产妇的危险因素进行非条件Logistic回归分析；对经保守疗法治疗无效的31例患者行紧急子宫切除术并分析治疗效果。结果：胎盘因素(β=0.95,OR=2.64)、子宫收缩无力(β=1.82,OR=5.48)、妊娠期高血压综合征(妊高征)(β=2.11,OR=6.97)和剖宫产(β=3.78,OR=28.04)是难治性产后出血的危险因素；31例行紧急子宫切除术患者的平均出血量为(2100±198)ml,其中29例(93.5%)经紧急子宫切除术治疗后恢复良好,2例因弥漫性血管内凝血或多脏器功能衰竭而死亡。结论：胎盘因素、子宫收缩无力、妊高征和剖宫产是难治性产后出血的危险因素,应积极防治,对于保守疗法无效的患者行紧急子宫切除术时,应密切关注手术指征及时机,提高手术安全性。
목적：：탐토인기난치성산후출혈적주요위험인소,병분석긴급자궁절제술적치료효과。방법：2008년6월~2012년5월124례아원수치적난치성산후출혈환자124례작위실험조,동기재아원주원적무산후출혈산부124례작위대조조,채용병례대조연구적방법대난치성산후출혈산부적위험인소진행비조건Logistic회귀분석；대경보수요법치료무효적31례환자행긴급자궁절제술병분석치료효과。결과：태반인소(β=0.95,OR=2.64)、자궁수축무력(β=1.82,OR=5.48)、임신기고혈압종합정(임고정)(β=2.11,OR=6.97)화부궁산(β=3.78,OR=28.04)시난치성산후출혈적위험인소；31례행긴급자궁절제술환자적평균출혈량위(2100±198)ml,기중29례(93.5%)경긴급자궁절제술치료후회복량호,2례인미만성혈관내응혈혹다장기공능쇠갈이사망。결론：태반인소、자궁수축무력、임고정화부궁산시난치성산후출혈적위험인소,응적겁방치,대우보수요법무효적환자행긴급자궁절제술시,응밀절관주수술지정급시궤,제고수술안전성。
Objective:To investigate the cause of the major risk factors for intractable postpartum hemorrhage and analysis of the therapeutic effect of the emergency hysterectomy.Methods:124 cases of intractable postpartum hemorrhage patients were deemed as experimental group from June 2008 to May 2012,124 cases of postpartum hemorrhage maternal were deemed as the control group over the same period in our hospital.The risk factors of intractable postpartum hemorrhage were analyzed by non-conditional logistic regression with the method of a case-control study.The treatment effect of emergency hysterectomy was analyzed in 31 patients after conservative therapy invalid.Results:Placental factors (β=0.95,OR=2.64),uterine atony (β=1.82,OR=5.48),pregnancy-induced hypertension (β=2.11,OR=6.97) and cesarean section (β=3.78,OR=28.04) were the risk factors of intractable postpartum hemorrhage.Average amount of bleeding was (2100±198)ml in 31 cases of patients who routine emergency hysterectomy,29 cases (93.5%) had good recovery after treatment,two cases dead due to disseminated intravascular coagulation,or multi-organ failuredied.Conclusion:Placenta,uterine atony,pregnancy-induced hypertension and cesarean are the risk factors of intractable postpartum hemorrhage,should actively combat. Patients underwent emergency hysterectomy should pay close attention to the indications for surgery and the timing when the conservative treatment ineffective.