产科产后出血行急症子宫切除术的相关因素临床研究

Clinical research on the related factors of postpartum hemorrhage implementing emergency hysterectomy

目的:探讨产科产后出血行急症子宫切除术的相关因素。方法:采用回顾性分析方法,对30例产后出血行急症子宫切除术患者的一般资料、失血量、手术方式、分娩方式、术后并发症、子宫切除指征以及母婴预后等情况进行汇总和分析。结果:急症子宫切除术指征中胎盘因素为46.7%(14/30),子宫因素为33.3%(10/30);经产妇占70.0%(21/30),剖宫产占83.3%(25/30),差异有统计学意义(P<0.05);胎盘前置出血量最大,平均(3 143.5±427.8)ml,羊水栓塞出血量最小,平均(2 101.3±252.5)ml;共发生术后并发症11例,其中胎盘前置最多,其次为宫缩乏力;产妇死亡3例,围产儿死亡6例。结论:胎盘因素是产后出血行急症子宫切除术的首要原因,其次为子宫因素,其中宫缩乏力仍是第一指征,多产次和剖宫产是高危因素。

Objective： To explore the related factors of postpartum hemorrhage implementing obstetric emergency hysterectomy. Methods： Using retrospective analysis methodology, 30 cases of postpartum hemorrhage implementation of emergency hysterectomy in patients with general information, blood loss, surgical approach, mode of delivery, complications, indications for hysterectomy, and maternal and infant outcomes was collected and analyzed. Results： The indications for emergency hysterectomy in the placental factors of 46. 7% （14/30） , uterine factor was 33.3% （10/30） ; By maternal 70. 0% （21/30）, cesarean section 83.3% （25/30） , the difference was significant （P 〈0.05） ; The largest amount of bleeding caused by placenta previa, the average （3 143.5 ±27. 8） ml, minimal blood loss of amniotic fluid embolism, the average （2 101.3 ±252. 5） ml; A total of 11 cases of postoperative complications , in which placenta previa, followed by uterine inertia; Maternal deaths in 2 cases and 6 cases of perinalal death. Conclusion： Placental factors is the primary reason of postpartum hemorrhage implementing emergency hysterectomy , followed by uterine factors, in which uterine inertia still is the first indication , productive times and cesarean section are risk factors.