APP下载

子宫压迫缝合治疗剖宫产产后出血效果评价

2016-09-21陈玲黄小琴

上海医药 2016年16期
关键词:产后出血剖宫产

陈玲+黄小琴

摘 要 目的:探讨子宫压迫缝合治疗剖宫产产后出血的临床效果。方法:选取2012年11月—2014年10月收治的剖宫产产后出血产妇85例,随机分为试验组43例,采用子宫压迫缝合治疗;对照组42例,采取传统手术治疗。观察两组手术时间、产后出血量、产褥病率、子宫切除率、平均住院时间、月经复潮时间。结果:试验组手术时间为(51.57±5.24)min,产后出血量为(672.48±26.84)ml,对照组手术时间为(67.84±6.21)min,产后出血量为(1 106.24±35.77)ml,组间差异有统计学意义(P<0.05)。试验组产褥病率和子宫切除率分别为4.65%(2/43)和0,对照组产褥病率和子宫切除率分别为28.57%(12/42)和9.52%(4/42),组间差异有统计学意义(P<0.05)。试验组平均住院时间为(6.21±1.94)d,低于对照组的(10.33±2.46)d(P<0.05)。结论:子宫压迫缝合治疗剖宫产产后出血的临床效果较好。

关键词 产后出血 子宫压迫缝合 剖宫产

中图分类号:R714.46+1 文献标志码:A 文章编号:1006-1533(2016)16-0021-02

Evaluation of the effect of uterine compression suture in the treatment of postpartum hemorrhage

CHEN Ling, HUANG Xiaoqin

(Department of Obstetrics and Gynecology of TCM Hospital, Dongxiang County, Jiangxi Province 331800, China)

ABSTRACT Objective: To investigate the clinical effect of uterine compression suture in the treatment of postpartum hemorrhage of cesarean section. Methods: From Nov. 2012 to Oct. 2014, 85 cases of caesarean postpartum hemorrhage were selected and randomly divided into an experiment group with 43 cases who were treated with uterine compression suture and a control group with 42 cases with conventional surgery. The operative time, postpartum bleeding, puerperal morbidity, hysterectomy rate, average hospital stay and menstruation after tide time were observed in the two groups. Results: The operation time was (51.57±5.24)min, and the amount of postpartum hemorrhage was (672.48 ± 26.84) ml in the experimental group, and the operation time was (67.84±6.21)min, and the amount of postpartum hemorrhage was (1106.24±35.77)ml in the control group, and there were significant differences between the two groups(P<0.05). Puerperal morbidity and hysterectomy rate were 4.65%(2/43) and 0 in the experimental group, puerperal morbidity and hysterectomy rates were 28.57%(12/42) and 9.52%(4/42) in the control group, and there were significant differences between the two groups(P<0.05). The average length of hospital stay in the experimental group was (6.21±1.94) d which was lower than that in the control group[ (10.33 ± 2.46)d, (P<0.05)]. Conclusion: The uterine compression suture has good clinical effect in the treatment of postpartum hemorrhage after cesarean section.

KEY WORDS postpartum hemorrhage; uterus oppression suture; caesarean

产后出血是产科常见并发症之一,是引起产妇死亡的主要原因之一。临床需积极有效的处理产后出血,挽救产妇生命[1]。研究有效的处理产后出血的方法,对于保障产妇生命、提高产妇生活质量具有重要意义。我院采用子宫压迫缝合术治疗产后出血疗效较好,现报道如下。

1 资料与方法

1.1 一般资料

选取我院2012年11月—2014年10月收治的剖宫产产后出血产妇85例,按照入院顺序随机均分为试验组和对照组。试验组43例,年龄为24~36岁,平均(28.49±6.54)岁,足月分娩;双胎妊娠17例,巨大儿10例,重度子痫前期10例,前置胎盘6例。对照组42例,年龄为24~35岁,平均(29.11±6.21)岁,足月分娩;双胎妊娠17例,巨大儿10例,重度子痫前期9例,前置胎盘6例。两组产妇的临床一般资料相比差异无统计学意义(P>0.05)。患者均签署知情同意协议书。排除合并其他疾病患者。

1.2 方法

对照组采取传统手术治疗,按摩子宫,热盐水纱布垫压迫出血部位,应用缩宫素,静脉应用止血药物,出血部位8字缝合,双侧子宫动脉上行支结扎、宫腔填塞纱条。

试验组采用子宫压迫缝合治疗,产妇均采取子宫下段剖宫产,用弧形5~6 cm的大圆针带0~1号可吸收线。将子宫托出腹腔,进行子宫压迫试验,加压后出血基本停止,则成功的可能性较大。手术后观察子宫收缩情况和阴道出血情况,宫缩好转的患者,阴道出血减少,则在宫底部中央褥式缝合浆肌层。宫缩乏力的产妇则从宫底到子宫下段行3~4个缝合。子宫放回腹腔后,进行观察,产妇情况正常则逐层关闭腹腔。

观察两组产妇手术时间、产后出血量、产褥病率、切除子宫率、平均住院时间和月经复潮时间。

1.3 统计学分析

2 结果

试验组产妇手术时间、产后出血量、褥病率、子宫切除率均低于对照组(P<0.05,表1)。试验组和对照平均住院时间分别为(6.21±1.94)d和(10.33±2.46)d,组间差异有统计学意义(P<0.05);月经复潮时间分别为(107.12±6.87)d和(111.32±6.44)d,组间差异无统计学意义(P>0.05)。

3 讨论

产后出血是分娩期严重的并发症,引起产后出血的原因较多,主要有子宫收缩乏力、产科因素、子宫因素等[2-4]。子宫收缩乏力的发生和产妇精神紧张和疲劳有关,产科因素主要包括产程延长、前置胎盘、妊高症等,子宫因素则多是子宫发育不良、瘢痕子宫等[5-7]。

子宫压迫缝合术是近年来采取的治疗产后宫缩乏力性出血的新方法[8-9]。本研究显示,试验组的手术时间、产后出血量低于对照组(P<0.05),提示采取子宫压迫缝合术治疗效果较好,手术风险降低。试验组产褥病率和子宫切除率低于对照组(P<0.05),表明子宫压迫缝合术治疗有利于产妇的产后恢复。另外,本研究显示,试验组平均住院时间低于对照组(P<0.05),这在一定程度上减轻了产妇家庭的经济负担。对于月经复潮情况,两组差异无统计学意义(P>0.05),表明子宫压迫缝合术治疗对月经恢复无影响。

目前,尽管产后止血方法有多种,如子宫动脉上行支结扎术、子宫动脉栓塞术等,但都对手术技术要求较高,而且手术时间长,损伤大[10-14]。采取子宫压迫缝合术,是十分可取的止血方法[15-16]。

参考文献

[1] 付景丽, 郑剑兰, 张小琼, 等. 剖宫产产后出血的临床分析[J]. 现代妇产科进展, 2012, 21(3): 215-217.

[2] Mishra N, Agrawal S, Gulabani K, et al. Use of an innovative condom balloon tamponade in postpartum haemorrhage: a report[J]. J Obstet Gynaecol India, 2016, 66(1): 63-67.

[3] Miller EC, Yaghi S, Boehme AK, et al. Mechanisms and outcomes of stroke during pregnancy and the postpartum period: A cross-sectional study[J]. Neurol Clin Pract, 2016, 6(1): 29-39.

[4] Tang PP, Hu HY, Gao JS, et al. Evaluation of efficacy and safety of pelvic arterial embolization in women with primary postpartum hemorrhage[J]. Zhonghua Fu Chan Ke Za Zhi, 2016, 51(2): 81-86.

[5] 王新彦, 李洪霞, 冀涛. 剖宫产产后出血的相关因素病例对照研究[J]. 中国妇幼保健, 2013, 28(6): 1052-1053.

[6] 宋杰, 王黎洲, 李兴, 等. 前置胎盘剖宫产术中行子宫动脉栓塞术对防治产后出血的应用[J]. 介入放射学杂志, 2013, 22(5): 418-421.

[7] Sathe NA, Likis FE, Young JL, et al. Procedures and uterinesparing surgeries for managing postpartum hemorrhage: a systematic review[J]. Obstet Gynecol Surv, 2016, 71(2): 99-113.

[8] Hanley GE, Smolina K, Mintzes B, et al. Postpartum hemorrhage and use of serotonin reuptake inhibitor antidepressants in pregnancy[J]. Obstet Gynecol, 2016, 127(3): 553-561.

[9] 吴仕元, 康昭海, 袁劲进. 产后出血预测评分及防治机制在预防剖宫产宫缩乏力性出血中的应用[J]. 中国现代医学杂志, 2011, 21(1): 115-119.

[10] Niola R, Giurazza F, Nazzaro G, et al. Uterine artery embolization before delivery to prevent postpartum hemorrhage[J]. J Vasc Interv Radiol, 2016, 27(3): 376-382.

[11] Raina S, Jearth V, Sharma A, et al. Postpartum pituitary apoplexy with isolated oculomotor nerve palsy: A rare medical emergency[J]. J Neurosci Rural Pract, 2015, 6(4): 598-600.

[12] 袁力, 何善阳, 陈淑琴. 两种不同方法应用欣母沛预防剖宫产产后出血的临床观察[J]. 中国妇幼保健, 2010, 25(34): 5115-5118.

猜你喜欢

产后出血剖宫产
一胎剖宫产,二胎必须剖吗
剖宫产和顺产,应该如何选择
剖宫产之父
腹膜外剖宫产术应用于二次剖宫产的疗效观察
不同给药方案对剖宫产术后出血产妇的心率及血压影响
益母草注射液联合缩宫素预防产后出血的临床疗效
探讨早吸吮早接触对产妇产后出血的影响
产后出血的护理措施及预防
米索前列醇对妊娠期高血压综合征产后出血的治疗作用研究
二次剖宫产与首次剖宫产的对比分析