称重法精确测量剖宫产术中、至术后出血量的前瞻性多中心临床研究

Clinical Measurement of Blood Loss by Weighing Method During and After the Cesarean Section:A Multi-Center,Perspective Trial.

目的探讨接受子宫下段剖宫产术产妇术中、至术后精确出血量的测量。方法采用多中心、前瞻性研究方法对2005年9月至2006年5月在四川省7所医院接受子宫下段剖宫产,且未合并明显增加出血疾病的产妇共计339例,采取称重法精确测量术中、至术后24 h出血量。结果1剖宫产术中出血量为(285.89±141.47)mL,至术后2 h总出血量为(334.68±159.78)mL,至术后24 h总出血量为(406.78±177.97)mL。剖宫产后出血发生率为24.48%(83/339)。2产次≥2次者,术中出血量、至术后2 h总出血量及至术后24 h总出血量均高于初产妇(P<0.05)。3疤痕子宫组(n=21)术中出血量、至术后2 h总出血量及至术后24 h总出血量均高于非疤痕子宫组(n=318)(P<0.05)。4单持麻醉组(n=286)术后(2～24)h出血量及24 h内总出血量高于双持麻醉组(n=52)(P>0.05)。结论子宫下段剖宫产术中、至术后出血量波动范围较大;经产妇、疤痕子宫和麻醉方式等,均是影响剖宫产出血量的因素。临床应采用称重法精确测定剖宫产出血量。

Objective To explore the acute blood loss during and after the cesarean section. Methods A multi center, perspective study was carried out on 339 cases of cesarean section without bleeding-associated complications in seven hospitals in Sichuan province from September 2005 to May 2006. The amount of blood loss during and after operation in 24 hours were measured by weighing method. Results ①The amount of blood loss during operation was （285.89±141.47）mL, and the total amount after 2 hours and 24 hours were （334.68±159.78）mL, （406.78±177.97）mL, respectively. The incidence of postpartum hemorrhage was 24.48% （83/339）. ②The blood loss during operation, as well as the cumulative blood loss in 24 hours after operation with pregnant women para 2 or greater were higher than primiparas（P〈0.05）. ③The blood loss during operation, as well as the cumulative blood loss in 24 hours after operation with scarred uterus （n=21） were higher than those with non scarred uterus（n= 318）（P〈0.05）. ④The blood loss in 2 to 24 hours after operation, as well as the cumulative blood loss in 24 hours with single injection epidural anesthesia （n=286） were higher than those with double-injection epidural anesthesia （n= 52）（P〈 0. 05）. Conclusion The blood loss during and after cesarean section fluctuates with wide range. Some factors such as multiparas, cicatricial uterus and types of anesthesia could influence the blood loss in cesarean section. Weighing method should be used in clinical practice to measure the amount of blood loss during the cesarean section.