CAJ | 학술논문

目的：探讨产后出血阶梯式评估及技术优化的临床价值，为产科临床提供参考。方法将2012年10月~2014年9月上海市嘉定区妇幼保健院(以下简称“我院”)收治的产后出血量≥400 mL的827例住院产妇(项目组)纳入出血阶梯式方案项目管理组，对其实施产后出血反复评估并不断改进止血新技术。观察管理期间项目组产妇缝合技术和止血新技术的实施情况、产后出血比例、宫缩剂有效比例及子宫切除比例等指标，并与2011年10月~2012年9月我院收治的384例产后出血量≥400 mL的产妇(对照组)进行比较，分析产后出血阶梯式评估及技术优化的临床价值。结果项目组新开展Cho缝合术比例与对照组比较差异有统计学意义(P<0.05)；项目组实施B-Lynch缝合术比例明显少于对照组(P<0.05)。项目组实施新技术子宫动脉结扎8例、子宫动脉栓塞8例，两项新技术均有1例为治疗有效。项目组产后出血发生率明显低于对照组(P<0.05)。结论产后出血阶梯式方案管理，通过对产后早期出血量进行正确评估，配合子宫按摩、药物促宫缩治疗和合理的止血术式，可以减少产后出血的发生。新技术子宫动脉栓塞与子宫动脉结扎能够提高产后出血的止血效果，值得在临床推广应用。
목적：탐토산후출혈계제식평고급기술우화적림상개치，위산과림상제공삼고。방법장2012년10월~2014년9월상해시가정구부유보건원(이하간칭“아원”)수치적산후출혈량≥400 mL적827례주원산부(항목조)납입출혈계제식방안항목관리조，대기실시산후출혈반복평고병불단개진지혈신기술。관찰관리기간항목조산부봉합기술화지혈신기술적실시정황、산후출혈비례、궁축제유효비례급자궁절제비례등지표，병여2011년10월~2012년9월아원수치적384례산후출혈량≥400 mL적산부(대조조)진행비교，분석산후출혈계제식평고급기술우화적림상개치。결과항목조신개전Cho봉합술비례여대조조비교차이유통계학의의(P<0.05)；항목조실시B-Lynch봉합술비례명현소우대조조(P<0.05)。항목조실시신기술자궁동맥결찰8례、자궁동맥전새8례，량항신기술균유1례위치료유효。항목조산후출혈발생솔명현저우대조조(P<0.05)。결론산후출혈계제식방안관리，통과대산후조기출혈량진행정학평고，배합자궁안마、약물촉궁축치료화합리적지혈술식，가이감소산후출혈적발생。신기술자궁동맥전새여자궁동맥결찰능구제고산후출혈적지혈효과，치득재림상추엄응용。
Objective To study the clinical value of step evaluation management for postpartum hemorrhage and the optimization of technology, to provide a reference for obstetrics clinic. Methods 827 cases hospitalized puerperal were brought into the bleeding ladder scheme project management group, which were treated in the Maternal and Child Health Hospital of Jiading District in Shanghai (“our hospital”for short) from October 2012 to September 2014 and the postpartum hemorrhage was more than 400 mL (project group), they were given the repeated assessment of postpartum hemorrhage and developed new hemostatic suture. The implementation of new technology and hemostatic suture tech-nique, the ratio of postpartum hemorrhage, proportion of effective tocolytic agents, and the ratio of uterus removal, etc. were observed. And those were compared with the 384 cases of hospitalized puerperal, which were treated in our hospi-tal from October 2011 to September 2012 (control group). The clinical value of step evaluation management and opti-mization techniques of hemostatic suture were analyzed. Results The rate of Cho hemostatic suture in the project group was higher than that of the control group, the difference was statistically significant (P<0.05). The implementation of B-Lynch suture of project group was less than that of the control group, the difference was statistically significant (P<0.05). In the project group, the implementation of new technology as uterine artery ligation in 8 cases and uterine artery embolization in 8 cases, with 1 case effectively. The incidence of postpartum hemorrhage of project group was lower than that of the control group, the difference was statistically significant (P<0.05). Conclusion The step evaluation man-agement can reduce the incidence of postpartum hemorrhage, thorough properly assessment of bleeding volume, uterine massage, the treatment with uterine contraction drugs and combined with reasonable operation of hemostasis. The uter-ine artery embolization and uterine artery ligation can improve the hemostatic effect of postpartum hemorrhage, worth to popularize application in the clinic.