宫腔纱条填塞法治疗中央型前置胎盘剖宫产术中大出血的效果分析

The bleeding uterine gauze treatment of central placenta previa cesarean section effectiveness analysis

目的:探讨中央型前置胎盘(CPP)患者剖宫产术术中出血应用宫腔纱条填塞法的止血效果及安全性分析。方法:回归性分析2009年1月～2012年12月收治的10例行剖宫产手术的CPP患者临床资料,患者术中均应用宫腔纱条填塞法进行止血,分析患者术中出血原因、宫腔纱条填塞指征及效果。结果:10例患者经抢救治疗后最终康复出院,患者术中出血量为650～2 520 ml,平均出血量为(1 152.6±58.3)ml,引起患者出血原因包括胎盘植入3例(30.00%)、CPP合并疤痕子宫3例(30.00%)、CPP合并子宫肌瘤2例(20.00%),CPP合并血小板减少1例(10.00%),合并重度子痫前期1例(10.00%),其中9例(90.00%)患者经宫腔纱条填塞法治疗后成功止血,1例(10.00%)胎盘植入患者行宫腔纱条填塞法止血失败,需改行子宫切除手术。经相关性分析显示,随着患者出血量增加,宫腔纱条填塞法的止血效果下降,两者呈负相关(r=-0.587,P=0.000),患者出血量越少,止血成功率越高,当出血量>2 000 ml,患者止血效果较差,与其他组相比差异具有统计学意义(P<0.05)。结论:对行剖宫产手术的CPP患者行宫腔纱条填塞法治疗能有效止血,可降低患者子宫切除率。

Objective： To investigate central placenta previa the cesarean section hemostatic effect of the application of bleeding u-terine gauze （CPP） patients. Methods： 10 patients with cesarean section CPP were applied uterine gauze method to stop the bleeding, the patientg blood loss reasons, uterine gauze indications and effect were analyzed. Results： 10 patients recovered and were discharged after sal-vage therapy ultimately, patient blood loss of 650 to 2 520 ml, the average amount of bleeding （ 1 152. 6 ± 58. 3 ） ml, the causes of bleed-ing in patients included placenta accreta 3 cases （30. 00% ）, CPP the combined uterine sear 3 cases （30. 00% ）, the CPP with uterine fi-broids 2 cases （20. 00% ）, the CPP merger thrombocytopenia 1 case （10. 00% ）, patients with severe pre - eclampsia 1 case （ 10. 00% ） . There were 9 （90%） patients with uterine gauze after successful treatment of bleeding, 1 case （ 10% ） of placenta accreta underwent uterine gauze law failed to control bleeding, should be diverted to a hysterectomy. The correlation analysis showed that, with the increasing in the amount of bleeding in patients, the decline in uterine gauze hemostatic effect of the law, negative correlation （ r = - 0. 587,P = O. 000）, less the amount of bleeding in patients, hemostasis success rate of more high, when the amount of bleeding 〉 2 000 ml, patients with poor hemostatic effect was statistically significant （P 〈 0. 05 ）, compared with other groups. Conclusion： The on cesarean section CPP patients uterine gauze treatment of can effectively stop bleeding, can reduce the rate of hysterectomy in patients.