中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
3期
385-387
,共3页
难治性产后出血%止血手术%失败原因
難治性產後齣血%止血手術%失敗原因
난치성산후출혈%지혈수술%실패원인
Intractable postpartum hemorrhage%Homeostasis%Failure reason
目的 比较5种止血手术治疗难治性产后出血的效果,分析止血失败的原因.方法 回顾性分析海南省海口市人民医院2009年7月至2013年5月105例难治性产后出血患者的临床资料.将所有患者根据实施不同的止血手术分为宫腔填塞组(37例)、压迫缝合组(28例)、联合组(15例)、血管结扎组(13组)和动脉栓塞组(12例).对比5组患者的术前出血量、术中出血量、总出血量、手术时间、输红细胞悬液、止血成功率、子宫切除率、转ICU率,并分析止血失败的原因.结果 动脉栓塞组及压迫缝合组的术中出血量明显少于血管结扎组[(260±90)、(454±79)ml比(1 101±122)ml],差异有统计学意义(均P＜0.05).动脉栓塞组手术时间明显短于压迫缝合组、联合组、血管结扎组和动脉栓塞组[(58±10)min比(84±17)、(92±11)、(105±22)、(120±21)min],差异有统计学意义(P＜0.05).动脉栓塞组止血成功率与子宫切除率与其他组比较[止血成功率:100.0%(12/12)比70.3%(26/37)、78.6%(22/28)、80.0%(12/15)、76.9%(10/13);子宫切除率:0%(0/12)比29.7%(11/37)、21.4%(6/28)、20.0%(3/15)、23.1%(3/13)],差异均有统计学意义(P＜0.05).止血失败的原因有患者为初产妇、产妇年龄高于35岁、多胎妊娠、瘢痕子宫、胎盘植入、前置胎盘、动脉栓塞治疗、剖宫产分娩、凝血功能障碍.其中,瘢痕子宫(OR=3.04,95%CI:1.05~7.54)、胎盘植入(OR=18.04,95%CI:5.72~57.93)、凝血功能障碍(OR=16.76,95%CI:3.34~82.96)是止血失败原因的高危因素.结论 宫腔填塞、压迫缝合、宫腔填塞联合压迫缝合、血管结扎、动脉栓塞5种止血方法均有不错的止血效果,但是介入治疗的成功率相对较高.影响止血失败的高危因素有胎盘植入、瘢痕子宫等,临床应该对症选择合适的止血方法,积极干预.
目的 比較5種止血手術治療難治性產後齣血的效果,分析止血失敗的原因.方法 迴顧性分析海南省海口市人民醫院2009年7月至2013年5月105例難治性產後齣血患者的臨床資料.將所有患者根據實施不同的止血手術分為宮腔填塞組(37例)、壓迫縫閤組(28例)、聯閤組(15例)、血管結扎組(13組)和動脈栓塞組(12例).對比5組患者的術前齣血量、術中齣血量、總齣血量、手術時間、輸紅細胞懸液、止血成功率、子宮切除率、轉ICU率,併分析止血失敗的原因.結果 動脈栓塞組及壓迫縫閤組的術中齣血量明顯少于血管結扎組[(260±90)、(454±79)ml比(1 101±122)ml],差異有統計學意義(均P＜0.05).動脈栓塞組手術時間明顯短于壓迫縫閤組、聯閤組、血管結扎組和動脈栓塞組[(58±10)min比(84±17)、(92±11)、(105±22)、(120±21)min],差異有統計學意義(P＜0.05).動脈栓塞組止血成功率與子宮切除率與其他組比較[止血成功率:100.0%(12/12)比70.3%(26/37)、78.6%(22/28)、80.0%(12/15)、76.9%(10/13);子宮切除率:0%(0/12)比29.7%(11/37)、21.4%(6/28)、20.0%(3/15)、23.1%(3/13)],差異均有統計學意義(P＜0.05).止血失敗的原因有患者為初產婦、產婦年齡高于35歲、多胎妊娠、瘢痕子宮、胎盤植入、前置胎盤、動脈栓塞治療、剖宮產分娩、凝血功能障礙.其中,瘢痕子宮(OR=3.04,95%CI:1.05~7.54)、胎盤植入(OR=18.04,95%CI:5.72~57.93)、凝血功能障礙(OR=16.76,95%CI:3.34~82.96)是止血失敗原因的高危因素.結論 宮腔填塞、壓迫縫閤、宮腔填塞聯閤壓迫縫閤、血管結扎、動脈栓塞5種止血方法均有不錯的止血效果,但是介入治療的成功率相對較高.影響止血失敗的高危因素有胎盤植入、瘢痕子宮等,臨床應該對癥選擇閤適的止血方法,積極榦預.
목적 비교5충지혈수술치료난치성산후출혈적효과,분석지혈실패적원인.방법 회고성분석해남성해구시인민의원2009년7월지2013년5월105례난치성산후출혈환자적림상자료.장소유환자근거실시불동적지혈수술분위궁강전새조(37례)、압박봉합조(28례)、연합조(15례)、혈관결찰조(13조)화동맥전새조(12례).대비5조환자적술전출혈량、술중출혈량、총출혈량、수술시간、수홍세포현액、지혈성공솔、자궁절제솔、전ICU솔,병분석지혈실패적원인.결과 동맥전새조급압박봉합조적술중출혈량명현소우혈관결찰조[(260±90)、(454±79)ml비(1 101±122)ml],차이유통계학의의(균P＜0.05).동맥전새조수술시간명현단우압박봉합조、연합조、혈관결찰조화동맥전새조[(58±10)min비(84±17)、(92±11)、(105±22)、(120±21)min],차이유통계학의의(P＜0.05).동맥전새조지혈성공솔여자궁절제솔여기타조비교[지혈성공솔:100.0%(12/12)비70.3%(26/37)、78.6%(22/28)、80.0%(12/15)、76.9%(10/13);자궁절제솔:0%(0/12)비29.7%(11/37)、21.4%(6/28)、20.0%(3/15)、23.1%(3/13)],차이균유통계학의의(P＜0.05).지혈실패적원인유환자위초산부、산부년령고우35세、다태임신、반흔자궁、태반식입、전치태반、동맥전새치료、부궁산분면、응혈공능장애.기중,반흔자궁(OR=3.04,95%CI:1.05~7.54)、태반식입(OR=18.04,95%CI:5.72~57.93)、응혈공능장애(OR=16.76,95%CI:3.34~82.96)시지혈실패원인적고위인소.결론 궁강전새、압박봉합、궁강전새연합압박봉합、혈관결찰、동맥전새5충지혈방법균유불착적지혈효과,단시개입치료적성공솔상대교고.영향지혈실패적고위인소유태반식입、반흔자궁등,림상응해대증선택합괄적지혈방법,적겁간예.
Objective To discuss the effect comparison on five hemostasis surgeries in the treatment of intractable postpartum hemorrhage and reason analysis of homeostasis failure. Methods The clinical data of 105 patients with intractable postpartum hemorrhage in the People's Hospital of Haikou City from July 2009 to May 2013 were retrospectively analyzed. All patients were divided into uterine packing group (37 cases), oppression suture group (28 cases), combined group (15 cases), vascular ligation group (13 cases) and arterial embolism group (12 cases). Preoperative blood loss, intraoperatve blood soss, the total blood loss, time of operation, red cells transfusion, success rate of hemostasis, the rate of uterus resection, intensive care unit (ICU) admission rate of five groups were compared, and the reasons for homeostasis failure were analyzed. Results Intraoperatve blood soss of arterial embolism group and oppression suture group were less than that of vascular ligation group [(260±90),(454±79)ml vs (1 101±122)ml], there were significant differences (P＜0.05). Time of operation of vascular ligation group was shorter than that of the other groups [(84±17),(92±11),(105±22),(120±21)min vs (58±10)min], there were significant differences (P＜0.05). There were significant differences on success rate of hemostasis and the rate of uterus resection in arterial embolism group compared with the other groups [success hemostasis:70.3%(26/37), 78.6%(22/28), 80.0%(12/15), 76.9%(10/13) vs 100.0%(12/12); uterus resection:29.7%(11/37), 21.4%(6/28), 20.0%(3/15), 23.1%(3/13) vs 0%(0/12)] (P＜0.05). There were some reasons of homeostasis failure such as patients of first-time mothers, age above 35 years old, multiple pregnancy, scarred uterus, placenta implantation, placenta previa, uterine rteril boliztion, cesarean delivery and coagulation disorders. Scarred uterus (OR=3.04, 95%CI:1.05-7.54), placenta implantation (OR=18.04,95%CI:5.72-57.93), coagulation disorders (OR=16.76, 95%CI:3.34-82.96) were high risk factor to the reason of homeostasis failure. Conclusion Five kinds of haemostatic method all have good haemostatic effect, but the intervention of the relatively high success rate. The appropriate methods and active intervention. Should be selected in symptomatic clinic to stop bleeding.
