剖宫产产后出血23例抢救体会

23 cases of postpartum hemorrhage rescue experience

目的将剖宫产产后出血量超过1000mL需抢救的23例患者的救治方法进行归纳总结,目的是降低产后出血率及产后出血量,提高产妇安全。方法对本院2009年1月～2011年11月所发生的剖宫产产后出血量超过1000mL的患者的治疗方法进行回顾性分析、总结。结果 3年孕产妇4817例中发生产后出血188例,其发生率为3.9%。其中剖宫产产后出血量超过1000mL的病例23例,导致产后出血的原因中,子宫收缩乏力17例(73.9%)居首位,其次胎盘因素3例(13.0%)、凝血功能障碍3例(13.0%)。出血量1000～2000mL12例,2000～4000mL10例,5000mL1例。结论严密观察产程,降低剖宫产率,对确需剖宫产者,要评估其高危因素,如存在有可能出现产后出血的危险因素者,应尽早采取积极抢救措施,如尽早注射卡前列素氨丁三醇、背带式缝合子宫、使用钙剂及双管补液等,对降低产后出血和孕产妇死亡起积极作用。

Objective To reduce rates of postpartum hemorrhage following delivery and secure the lives of pregnant women,treatment methods of postpartum hemorrhage were summarized based on 23 cases where loss of blood was more than 1 000 mL and urgency rescue is needed.Methods During the period between January 2009 and November 2011,treatment methods of postpartum hemorrhage were investigated and analyzed.Results In three years 4 817 cases of maternal postpartum hemorrhage in 188 cases,the incidence was 3.9%.The postpartum hemorrhage of cesarean section over 1 000 mL 23 cases,lead to the causes of postpartum hemorrhage,uterine atony ranks first in 17 cases（73.9%）,followed by placental factors in 3 cases（13.0%）,blood coagulation dysfunction in 3 cases（13.0%）.The amount of bleeding in 12 cases of 1 000 ~ 2 000 mL,2 000 ~ 40 00 mL 10 cases,5 000 mL 1 case.Conclusion By closely observing the delivery procedure,it is concluded that to reduce the rate of cesarean section,highly risky factors should be considered.The potential existence of postpartum hemorrhage should be prevented by injecting Carboprost Tromethamine,conducting Brace suture of uterus,and using calcium agent and double fluid replacement.All aforesaid methods could have a positive effect on reduction of postpartum hemorrhage and mortality rate.