卡前列素氨丁三醇联合低位B-Lynch缝合术治疗难治性前置胎盘性产后出血的临床分析

Romethamine Combined With Low B-Lynch Suture in the Treatment of Refractory Postpartum Hemorrhage Induced by Placenta Previa

目的探讨卡前列素氨丁三醇联合低位B-Lynch缝合术治疗难治性前置胎盘性产后出血(PPH)的临床疗效。方法回顾性分析2005年1月至2011年1月在本院因前置胎盘行剖宫产分娩,经保守治疗无效确诊为难治性PPH38例为研究对象,其累计出血量达1000mL。38例患者立即宫体注射卡前列素氨丁三醇250μg,同时根据孕周采取低位B-Lynch缝合术。观察术后24h阴道流血量、术后子宫复旧及血性恶露持续时间;术后7d,14d及42d分别行超声检查,了解宫腔、子宫切口及子宫大小情况;术后半年及1年分别电话随访患者月经恢复时间及情况(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,并与受试者签署临床研究知情同意书)。结果本组38例患者产后出血量达(1500～3000)mL,且均成功止血,并成功保留子宫及其生理功能。术后随访6,12个月显示,子宫复旧好,无一例发生晚期PPH,月经于术后4～11个月均恢复。结论卡前列素氨丁三醇联合低位B-Lynch缝合术,治疗难治性前置胎盘性PPH的疗效确切,手术时间短、易于掌握,值得临床推广应用。

Objective To discuss romethamine combined with low B-Lynch suture in the treatment of refractory postpartum hemorrhage （PPH） induced by placenta previa. Methods From January 2005 to January 2011, a total of 38 cases with cesarean section because of placenta praevia were included into this study. They were all diagnosed as refractory PPH. The cumulative haemorrhage amount was 1000 mL. They were received immediate injection of romethamine 250 /~g, at the same time take low B-Lynch suture technique according to different gestational age. The following items were observed, vaginal bleeding volume in 24 h after surgery, postoperative uterine instauration and hemorrhagic duration of lochia, ultrasound examination in 7 d, 14 d and 42 d after surgery, et al. There was no significant difference in general condition among three groups （P〈0.05）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Renmin Hospital Affiliated to Hubei University of Medicine. Informed consent was obtained from all participates. Results Thirty-eight cases of patients with postpartum blood loss accounted to （1500-3000） mL, and all successful hemostasis and remain the integrity of the uterus avoiding hysterectomy. Postoperative follow-up of six to twelve months showed no one occurred late PPH and menstruation recovery in 4-11 months after surgery. Conclusions Romethamine combined with low B- Lynch suture in the treatment of refractory PPH induced by placenta previa is of short operation time, good efficacy and worthy of clinical popularization and application.