加压填纱在中央性前置胎盘剖宫产术中的应用

The Application of Pressure to Fill in the Yarn in the Central front of the Placenta Cesarean Section

目的探讨中央性前置胎盘剖腹产术中止血的方法。方法 2009年1月至2011年12月住院分娩的中央性前置胎盘40例,随机分为观察组和对照组各20例。2组患者在年龄、孕产次、孕周、前置胎盘类型、剖宫产史、宫腔操作史等方面无明显差异,无统计学意义。2组皆根据刘正平等提出的胎盘边缘切口原则选择子宫切口,在胎儿娩出后宫体注射缩宫素20U,舌下含化米索前列醇片400～600ug。胎盘娩出后,立即将子宫娩出腹腔;观察组用40cm×30cm的4层纱垫1～3块填塞子宫下段,助手压迫子宫下段,术者立即缝合子宫切口至2/3时取出纱垫,换干净纱垫压于子宫下段外,助手挤压子宫下段,术者继续缝合子宫切口完毕;边加压填纱边缝合子宫切口,历时约4～6min。对照组不用加压填纱法。结果观察组术中出血(300±100)ml,手术时间(50±20)min,无子宫切除者。对照组术中出血(600±150)ml,手术时间(90±30)min,子宫切除者2例。观察组明显优于对照组(P<0.05)。结论加压填纱子宫下段在中央性前置胎盘剖宫产术中止血迅速、简单易学、操作方便,适合临床推广应用。

Objective To study the central front of intraoperatie bleeding placenta cesarean section method. Methods From January 2009 to December 2011 inpatient delivery of 40 patients with the central front the placenta, were randomly divided into trial group and control group every 20 cases. Two groups of patients in age, in time, with gestational age at the placenta, front type, cesarean section history, history of uterine cavity operation aspects no obvious difference, no statistical significance. Two groups are according to LiuZhengPing etc [1] the placenta edge incision put forward the principle to choose the womb incision, fetal childbirth in song after injection oxytocin 20 U, including the tongue of misoprostol piece of 400 ~ 600 ug. The control group need not fill pressure yam method. Results The observation group intraoperatie bleeding （300 _＋ 100） ml, operation time （50 ＋ 20） min, without the hysterectomy. The control group intraoperatie bleeding （600 ~ 1＇50） ml, operation time （90 ＋ 30） min, the hysterectomy in 2 cases. The observation group is much better than control group （P 〈 0.05）. Conclusion Pressure fill in the yam lower uterine segment in the central front of intraoperatie bleeding placenta cesarean section quickly and easily to learn, convenient operation, and suitable for clinical application.