产后出血223例临床分析

Analysis on 223 cases of post-partum hemorrhage

目的:探讨产后出血的原因及有效治疗措施。方法:对本院1997年1月至2003年12月住院分娩的 223例产后出血患者的临床资料进行回顾性分析,探讨其病因及防治措施。结果:223例产后出血原因:宫缩乏 力137例(61.43%),胎盘因素63例(28.25%),软产道损伤因素11例(4.93%),凝血功能障碍12例 (5.38%)。223例中159例经保守治疗后(未行宫腔填塞纱条),138例效果满意;21例效果不佳(包括3例DIC, 4例失血性休克,1例胎盘早剥合并死胎,4例胎盘卒中,3例胎盘植入,1例双胎合并先兆子痫,1例子宫破裂,4 例子宫收缩乏力),行子宫次全切除术。64例常规保守治疗无效后,及时行宫腔填塞纱条治疗,61例效果满意;3 例(1例妊娠合并黏膜下肌瘤,1例妊娠合并乙肝,1例多胎妊娠合并先兆子痫)效果不满意,急行子宫次全切除 术。与产后出血未采用宫腔填塞纱条组相比,采用宫腔填塞纱条组子宫切除率显著下降(4.69%vs11.32%, P<0.05)。223例产后出血中剖宫产子宫切除率明显高于阴道分娩组(P<0.05)。结论:宫缩乏力、胎盘因素是 产后出血的主要原因,宫腔填塞纱条是治疗产后出血、保留子宫的有效措施,对经保守治疗措施(尤其宫腔填塞 纱条)无效者,应果断及时采取子宫切除术。

Aim: To study the causes of post-partum hemorrhage and explore the effective managements. Methods: The clinical materials of 223 patients with post-partum hemorrhage from January 1997 to December 2003 were retrospectively investigated.Results: The causes of hemorrhage: 137(61.43%) cases were uterine inertia, 63(28.25%) cases were placenta factor , 11(4.93%) cases were laceration of the lower genital tract , and 12(5.38%)cases were coagulation defects. Out of 223 cases of post-partum hemorrhage, 159 patients accepted conservative treatment,among whom,the bleeding of 138 patients were well controlled,and 21 patients accepted subtotal hysterectomy.The remained 64 patients accepted uterine packing after conservative treatment,61 patients were controlled,and 3 patients were undergone subtotal hysterectomy; none was infected or died.The hysterectomy rate of the packing group was lower than unpacking group (4.69% vs 11.32%, P<0.05). The hysterectomy rate of cesarean section group was higher than vaginal delivery group.Conclusion: Uterine packing is a useful method for post-partum hemorrhage. The application of hysterectomy to manage inefficiency of conservative method is necessary in post-partum hemorrhage.