孕产妇宫缩乏力“死亡者”与“幸存者”相关因素对比研究

Comparative study on the related factors of "the Death" and "the Survival" among the pregnant women with uterine inertia

目的:对产后宫缩乏力进行相关研究,从中寻找孕产妇幸运生存下来的宝贵经验,为可持续性地降低孕产妇死亡提供科学依据。方法:对贵州省58个"降消"项目县4年间在县乡级医院住院孕产妇,发生宫缩乏力死亡者42例与发生宫缩乏力严重者由于幸运和得到了良好的救治而存活的39例孕产妇,进行对比研究。结果:两组在产次、入院时病情、分娩地点、发生原因等方面无明显差异(P>0.05);两组在分娩过程中使用药物情况、处理方法、治疗抢救情况等均有显著差异(P<0.05),幸存组宫缩乏力处理方法以按摩子宫配合宫缩剂及宫腔填纱布为主,占79.49%。死亡组宫缩素给药途径75%是肌注,幸存组是宫缩素静滴配合使用米索占82.05%。结论:正确使用宫缩剂是减少阴道流血的重要手段,早发现、早处理宫缩乏力致产后出血是阻断死亡之路的关键。宫按摩法配合宫缩剂及宫腔填塞纱布应用可以明显减少产后出血量,方法简单易行,安全有效,值得在基层推广。

Objective：To study the related factors of postpartum uterine inertia,find out valuable experiences from the lucky survivors among the pregnant women,provide scientific basis for reducing maternal mortality constantly. Methods：42 dead pregnant women because of uterine inertia and 39 survival pregnant women with uterine inertia were selected and compared,all the pregnant women were from hospitals at village and county levels in 58 project counties. Results：There was no significant difference in the times of delivery,disease severity on admission,places of delivery and causes between the two groups（P〈0.05）.There was significant difference in usage condition of drugs during delivery,treatment and rescue conditions between the two groups（P〈0.05）.In survival group,the main treatment of uterine inertia was massaging uteri combined with oxytocin and filling gauze into uterine cavity,accounting for 79.49%.In death group,75% of the routes of giving medicine were intramuscular injection;while in survival group,82.05% of the cases were treated with intravenous drip of oxytocin combined with misoprostol. Conclusion：Correct usage of oxytocin is an important method to reduce vaginal bleeding,early detection and early treatment of uterine inertia are the key points to prevent death.Massaging uteri combined with oxytocin and filling gauze into uterine cavity can reduce the volume of postpartum hemorrhage obviously,the method is simple and easy to operate,safe and effective,and it is worthy to be spreaded in town-level hospitals.