CAJ | 학술논문

目的：探讨疤痕子宫剖宫产术中出血的因素与预防措施。方法随机该院2010年3月—2014年12月收治的120例疤痕子宫剖宫产的产妇,同时选择同期首次剖宫产产妇120例作为对照组,观察产妇术中出血情况并及时进行止血。结果观察组发生术中出血16例,术中出血率为13.3%,出血量为(526±266)mL,对照组发生术中出血8例,术中出血率为6.7%,出血量为(320±180)mL,两组比较差异有统计学意义(P<0.05),观察组出血量为(526±266)mL,对照组出血量为(320±180) mL,两组比较差异有统计学意义(P<0.05),观察组由于子宫破裂导致出血1例,宫缩乏力因素2例,切口撕裂因素3例,胎盘因素10例,对照组宫缩乏力因素2例,切口撕裂因素2例,胎盘因素4例,两组产妇在子宫破裂、宫缩乏力和胎盘因素比较差异有统计学意义(P<0.05),观察组16例患者采取止血带加B-lychn缝合止血6例,纱布宫腔填塞止血3例,子宫动脉上行支缝扎止血3例,子宫局部缝扎止血4例,对照组8例术中出血产妇采取纱布宫腔填塞止血5例,子宫局部缝扎止血3例,两组患者均成功止血,无死亡产妇发生。结论导致疤痕子宫剖宫产术中出血的主要因素是子宫破裂、宫缩乏力和胎盘因素是,止血带加B-lychn缝合止血、纱布宫腔填塞止血、子宫动脉上行支缝扎止血和子宫局部缝扎止血是常用的止血措施。
목적：탐토파흔자궁부궁산술중출혈적인소여예방조시。방법수궤해원2010년3월—2014년12월수치적120례파흔자궁부궁산적산부,동시선택동기수차부궁산산부120례작위대조조,관찰산부술중출혈정황병급시진행지혈。결과관찰조발생술중출혈16례,술중출혈솔위13.3%,출혈량위(526±266)mL,대조조발생술중출혈8례,술중출혈솔위6.7%,출혈량위(320±180)mL,량조비교차이유통계학의의(P<0.05),관찰조출혈량위(526±266)mL,대조조출혈량위(320±180) mL,량조비교차이유통계학의의(P<0.05),관찰조유우자궁파렬도치출혈1례,궁축핍력인소2례,절구시렬인소3례,태반인소10례,대조조궁축핍력인소2례,절구시렬인소2례,태반인소4례,량조산부재자궁파렬、궁축핍력화태반인소비교차이유통계학의의(P<0.05),관찰조16례환자채취지혈대가B-lychn봉합지혈6례,사포궁강전새지혈3례,자궁동맥상행지봉찰지혈3례,자궁국부봉찰지혈4례,대조조8례술중출혈산부채취사포궁강전새지혈5례,자궁국부봉찰지혈3례,량조환자균성공지혈,무사망산부발생。결론도치파흔자궁부궁산술중출혈적주요인소시자궁파렬、궁축핍력화태반인소시,지혈대가B-lychn봉합지혈、사포궁강전새지혈、자궁동맥상행지봉찰지혈화자궁국부봉찰지혈시상용적지혈조시。
Objective To discuss the factors and prevention of intraoperative hemorrhage in cesarean section with scar uterus. Methods 120 parturient women with scar uterus who underwent cesarean section in our hospital between March 2010 and Decem-ber 2014 were assigned to the observation group and other 120 parturient patients who underwent primary cesarean delivery in the same period were assigned to the control group. The bleeding was observed and timely hemostasis was done. Results There were 16 cases (13.3%) of intraoperative hemorrhages in the observation group and 8 cases (6.7%) in the control group, and the differ-ence was statistically significant(P<0.05). The hemarragic volume was (526±266)mL in the observation group and (320±180)mL in the control group, and the difference was statistically significant(P<0.05). In the observation group, 1 case of hemorrhage was due to uterine rupture, 2 cases due to uterine inertia, 3 cases due to incision laceration, 10 cases due to placenta factor, while in the control group, 2 cases due to uterine inertia, 2 cases due to incision laceration, 4 cases due to placenta factor, and in terms of factors, including uterine rupture, uterine inertia and placenta factor, there were statistically significant differences between the two groups(P<0.05). In the observation group, tourniquet combined B-lychn sutures was performed in 16 cases, uterine packing with gauzes in 3 cases, ascending branch of uterine artery ligation in 3 cases, local uteri suture-ligation in 4 cases, while in the control group, uterine packing with gauzes was performed in 5 cases and local uteri suture-ligation in 3 cases. Bleeding was successfully stopped in all the parturient patients with no deaths. Conclusion The factors of intraoperative hemorrhage in cesarean section with scar uterus included uterine rupture, uterine inertia and placenta factor, and tourniquet combined B-lychn sutures, uterine packing with gauzes, ascending branch of uterine artery ligation and local uteri suture-ligation were the common measures.