宫腔纱条填塞法治疗中央型前置胎盘剖宫产术中大出血70例临床分析

Clinical Analysis of 70 Cases With Uterine Packing in the Management of Massive Hemorrhage During Cesarean Section With Central Placenta Previa

目的探讨宫腔纱条填塞法治疗中央型前置胎盘剖宫产术中大出血的止血效果。方法回顾性分析2005年11月至2010年3月在本院确诊为中央型前置胎盘,并采用宫腔纱条填塞法治疗剖宫产术中大出血70例患者的临床资料,分析术中出血原因,宫腔纱条填塞指征、方法及效果(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与研究对象签署临床研究知情同意书)。进行接受宫腔纱条填塞时出血量与填塞治疗效果比较。结果 70例患者全部抢救成功,其中65例(92.86%)宫腔纱条填塞法成功,5例(7.14%)宫腔纱条填塞失败,行子宫切除术。术中出血量与填塞治疗效果比较显示,术中宫腔纱条填塞时出血量与填塞效果密切相关(r=-0.706,P<0.05),且填塞时出血量越少,填塞效果越好,差异有显著意义(P<0.05)。结论宫腔纱条填塞是一种安全、有效的治疗中央型前置胎盘剖宫产术中大出血的方法。

Objective To explore the effectiveness of uterine packing in controlling of intractable hemorrhage during cesarean section with central placenta previa. Methods This retrospective study was conducted on clinical data of 70 pregnant women who were diagnosed with central placenta previa from May 2005 to March 2010, and uterine packing has been used in cases of massive hemorrhage during cesarean section. Causes of hemorrhage, the indication of uterine packing, uterine packing procedure and effectiveness were analyzed, and the volume of uterine bleeding during packing and effectiveness of uterine packing were compared. Informed consent was obtained from all participates. Results All 70 cases were successfully salvaged, in which 65 cases（92.86%） were successfully in controlling of intraoperative bleeding with uterine cavity ribbon gauze packing; in which 5 cases（7. 14%）failed and had hysterectomy. The comparison showed that blood loss during packing （r= 0.706, P〈0.05）. And the less blood loss were closely related to effectiveness of uterine packing when packing, ＂the better effect, there were significant difference（P〈0. 05）. Conclusion Uterine packing is a safe and effective technique in controlling of intractable hemorrhage during cesarean section with central placenta previa.