CAJ | 학술논문

目的：探讨难治性产后出血急症子宫切除术的原因、抢救难治性产后出血中的手术时机及孕产妇结局，为预防和处理产后大出血提供依据。方法采用回顾性研究方法对2010年至2014年在西北妇女儿童医院分娩的46例因产后出血行急症子宫切除术患者的临床资料进行分析。结果5年间共住院分娩56436例，有582例发生了产后出血，产后出血发生率1.03％；其中46例患者经保守治疗出血仍不能控制，实施了急症子宫切除术。产后出血原因为：胎盘因素（43.48％，20／46），宫缩乏力（36.96％，17／46），胎盘因素合并宫缩乏力（10.87％，5／46），羊水栓塞（4.35％，2／46）和晚期产后出血感染（4.35％，2／46）。出血量1500～4000 ml，平均（2783±625） ml。46例患者均行急症子宫切除术后痊愈出院。结论急症子宫切除术是产后大出血经保守治疗无效时抢救孕产妇生命的有效措施，胎盘因素是急诊子宫切除的主要原因，做好产后出血的预防与处理可以有效地降低围生期子宫切除率。
목적：탐토난치성산후출혈급증자궁절제술적원인、창구난치성산후출혈중적수술시궤급잉산부결국，위예방화처리산후대출혈제공의거。방법채용회고성연구방법대2010년지2014년재서북부녀인동의원분면적46례인산후출혈행급증자궁절제술환자적림상자료진행분석。결과5년간공주원분면56436례，유582례발생료산후출혈，산후출혈발생솔1.03％；기중46례환자경보수치료출혈잉불능공제，실시료급증자궁절제술。산후출혈원인위：태반인소（43.48％，20／46），궁축핍력（36.96％，17／46），태반인소합병궁축핍력（10.87％，5／46），양수전새（4.35％，2／46）화만기산후출혈감염（4.35％，2／46）。출혈량1500～4000 ml，평균（2783±625） ml。46례환자균행급증자궁절제술후전유출원。결론급증자궁절제술시산후대출혈경보수치료무효시창구잉산부생명적유효조시，태반인소시급진자궁절제적주요원인，주호산후출혈적예방여처리가이유효지강저위생기자궁절제솔。
Objective To explore the risk factors and the time of hysterectomy for intractable postpartum hemorrhage .Methods A retrospective analysis was performed on 46 cases of emergency hysterectomy for postpartum hemorrhage , who were admitted to our hospital between January 2010 and December 2014.Results During five years, there were total 56436 delivery cases and 582 cases of postpartum hemorrhage in our hospital .The incidence rate of postpartum hemorrhage was 1.03%.46 cases were processed emergency hysterectomy due to inefficient conservative theatments . The causes of postpartum hemorrhage incuded placenta factors ( 43.48%, 20/46 ) , uterme atony ( 36.96%, 17/47 ) , uterme atony with placenta factors (10.87%,5/46), amnionic fluid embolism (4.35%,2/46), and late postpartum hemorrhage(4.35%,2/46).Range of blood loss was 1 500~4 000 ml.The average of blood loss was 2855 ±500 ml.All of 46 patients were recovered .Conclusions Emergency hysterectomy is effective treatment for severe postpartum hemorrhage with inefficient conservative theatments .Placenta factors is the main cause of emergency hysterectomy .We should take effective measures in prevention and treatment of postpartum hemorrhage in order to reduce the occurrence rate of hysterectomy .