中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
Chinese Journal of Perinatal Medicine
2015年
11期
838-842
,共5页
晋柏%王清%张婷婷%孙丽洲
晉柏%王清%張婷婷%孫麗洲
진백%왕청%장정정%손려주
前置胎盘%产后出血%子宫动脉栓塞术%子宫切除术%再手术%危险因素
前置胎盤%產後齣血%子宮動脈栓塞術%子宮切除術%再手術%危險因素
전치태반%산후출혈%자궁동맥전새술%자궁절제술%재수술%위험인소
Placenta previa%Postpartum hemorrhage%Uterine artery embolization%Hysterectomy%Reoperation%Risk factors
目的 分析前置胎盘患者发生非计划重返手术的原因,探讨减少和防范前置胎盘患者非计划重返手术的临床对策. 方法 回顾性分析南京医科大学第一附属医院产科2010年1月至2015年1月收治的571例前置胎盘患者中,行非计划重返手术的10例患者(1.75％)的临床资料.结果 10例患者中,7例因剖宫产术后发生严重出血而行非计划重返手术(术式包括子宫动脉介入栓塞术或者子宫切除术).3例前置胎盘中期妊娠行利凡诺引产术,其中2例联合子宫动脉介入栓塞术,术后因继发严重感染行剖宫取胎术;1例引产时因发生大出血转入本院行剖宫取胎术,术后再次发生严重产后出血,行子宫切除术.10例中的8例发生严重产后出血,平均出血总量(4 212±1 651)ml,第一次手术返回病房后再次出血量(2 206±736)ml,8例患者平均输注红细胞(23.7±9.0)U,输注血浆[M(min～max)]为1 845(390～3 960) ml,输注血小板5例、冷沉淀8例、白蛋白6例,纤维蛋白原5例.2次手术间隔时间[M(min～max)]为2.0(0.5～19.0)h.二次手术后平均住院时间(10.6±2.5)d,平均使用抗生素(9.2±2.3)d.10例产妇均治愈出院,7例剖宫产儿预后良好.结论 前置胎盘患者发生非计划重返手术的主要原因是首次手术后的严重产后出血.加强手术后监测,早期诊断及迅速手术,是控制严重产后出血、挽救孕产妇生命的重要手段.
目的 分析前置胎盤患者髮生非計劃重返手術的原因,探討減少和防範前置胎盤患者非計劃重返手術的臨床對策. 方法 迴顧性分析南京醫科大學第一附屬醫院產科2010年1月至2015年1月收治的571例前置胎盤患者中,行非計劃重返手術的10例患者(1.75％)的臨床資料.結果 10例患者中,7例因剖宮產術後髮生嚴重齣血而行非計劃重返手術(術式包括子宮動脈介入栓塞術或者子宮切除術).3例前置胎盤中期妊娠行利凡諾引產術,其中2例聯閤子宮動脈介入栓塞術,術後因繼髮嚴重感染行剖宮取胎術;1例引產時因髮生大齣血轉入本院行剖宮取胎術,術後再次髮生嚴重產後齣血,行子宮切除術.10例中的8例髮生嚴重產後齣血,平均齣血總量(4 212±1 651)ml,第一次手術返迴病房後再次齣血量(2 206±736)ml,8例患者平均輸註紅細胞(23.7±9.0)U,輸註血漿[M(min～max)]為1 845(390～3 960) ml,輸註血小闆5例、冷沉澱8例、白蛋白6例,纖維蛋白原5例.2次手術間隔時間[M(min～max)]為2.0(0.5～19.0)h.二次手術後平均住院時間(10.6±2.5)d,平均使用抗生素(9.2±2.3)d.10例產婦均治愈齣院,7例剖宮產兒預後良好.結論 前置胎盤患者髮生非計劃重返手術的主要原因是首次手術後的嚴重產後齣血.加彊手術後鑑測,早期診斷及迅速手術,是控製嚴重產後齣血、輓救孕產婦生命的重要手段.
목적 분석전치태반환자발생비계화중반수술적원인,탐토감소화방범전치태반환자비계화중반수술적림상대책. 방법 회고성분석남경의과대학제일부속의원산과2010년1월지2015년1월수치적571례전치태반환자중,행비계화중반수술적10례환자(1.75％)적림상자료.결과 10례환자중,7례인부궁산술후발생엄중출혈이행비계화중반수술(술식포괄자궁동맥개입전새술혹자자궁절제술).3례전치태반중기임신행리범낙인산술,기중2례연합자궁동맥개입전새술,술후인계발엄중감염행부궁취태술;1례인산시인발생대출혈전입본원행부궁취태술,술후재차발생엄중산후출혈,행자궁절제술.10례중적8례발생엄중산후출혈,평균출혈총량(4 212±1 651)ml,제일차수술반회병방후재차출혈량(2 206±736)ml,8례환자평균수주홍세포(23.7±9.0)U,수주혈장[M(min～max)]위1 845(390～3 960) ml,수주혈소판5례、랭침정8례、백단백6례,섬유단백원5례.2차수술간격시간[M(min～max)]위2.0(0.5～19.0)h.이차수술후평균주원시간(10.6±2.5)d,평균사용항생소(9.2±2.3)d.10례산부균치유출원,7례부궁산인예후량호.결론 전치태반환자발생비계화중반수술적주요원인시수차수술후적엄중산후출혈.가강수술후감측,조기진단급신속수술,시공제엄중산후출혈、만구잉산부생명적중요수단.
Objective To analyze reasons for unplanned return-to-theater obstetrical surgery in patients with placenta previa, and to propose a strategy for prevention.Methods Among 571 patients with placenta previa in the Department of Obstetrics, First Affiliated Hospital of Nanjing Medical University from January 2010 to January 2015, ten cases (1.75％) who had an unplanned return-to-theater obstetrical surgery were retrospectively analyzed.Results Seven out of the ten cases returned to the theater due to severe hemorrhage after cesarean section and hysterectomy or uterine artery embolization was performed.The rest three pregnancies were terminated at mid-term with amniotic injection of rivanol, two of which developed severe infection after the induction combined with uterine artery embolization followed by cesarean section,and the other one finally had an emergent hysterectomy due to severe postpartum hemorrhage after cesarean section because of intrapartum hemorrhage.Severe postpartum hemorrhage occurred in eight out of the ten cases, with a mean volume of (4 212± 1 651) ml.Blood loss between the original and return-to-theater surgery was (2 206± 736) ml.In these eight cases, the mean volume of erythrocyte suspension transfusion was (23.7±9.0) U, and [M(min-max)] 1 845(390 3 960) ml for plasma transfusion.Platelet transfusion was performed in five cases, cryoprecipitate transfusion in eight cases, serum albumin transfusion in six cases, and fibrinogen transfusion in five cases.The interval between original and return-to-theater surgery was 2.0(0.5-19.0) h.After the return-to theater surgery, the time of antibiotic use was (9.2±2.3) d, and the duration of hospital stays was (10.6±2.5) d.No patient required further re-operation, and all were discharged without long-term sequelae.All seven neonates had a good prognosis.Conclusions Severe postpartum hemorrhage in patients after initial operation because of placenta previa is the primary indication for unplanned return-totheater surgery.Closed postoperative monitoring, early recognition and expedite return-to-theater surgery are crucial to stop bleeding and save lifes.
