产科心肺复苏后子宫切除的实施

Hysterectomy after cardiopulmonary resuscitation in patients with obstetric hemorrhagic shock

目的调查产科失血性休克所致心跳骤停的产妇复苏后子宫切除情况,探讨子宫切除在抢救患者生命时的指征及相关因素。方法通过回顾性调查近5年来广州市部分医院对因产科失血性休克致心跳骤停13例患者,12例积极实施了子宫切除,1例行子宫动脉栓塞术。结果对13例心跳骤停后复苏成功而子宫仍有活动性出血者实施了子宫切除术或子宫动脉栓塞术,仅4例存活。结论围分娩期准备充分,积极抢救产科失血性休克,早期复苏,适时切除子宫,重视血管介入治疗是复苏成功及提高存活率的关键。

Objective To explore the indication of hysterectomy after successful resuscitation of cardiac arrest due to obstetric hemorrhagic shock. Methods A retrospective analysis was conducted in 13 patients with cardiac arrest due to obstetric hemorrhagic shock in 7 hospitals of Guangzhou, including 12 patients undergoing hysterectomy and 1 undergoing uterine artery embolization. Results After successful cardiopulmonary resuscitation, only 4 of the 13 patients undergoing hysterectomy or uterine artery embolization for continuing uterus hemorrhage survived. Conclusions Detailed plans and emergency measures should be formulated in the management of high-risk pregnancies. Early diagnosis and active treatment of obstetric hemorrhagic shock with hysterectomy or uterine artery embolization are critical in preventing cardiac arrest and improving the survival of the patients.