顽固性产后出血的干预措施及其对产妇生存质量的影响

Intervention Measure and Its Influence on Quality of Life of Puerpera with Intractable Postpartum Hemorrhage

目的探讨不同干预措施在顽固性产后出血抢救中的临床价值及其对产妇生存质量的影响.方法回顾性分析2005年5月至2011年12月大理州人民医院收治的55例顽固性产后出血患者的临床资料,其中9例成功接受药物治疗,15例成功接受介入栓塞治疗,14例成功接受宫腔纱布填塞治疗,12例成功接受B-Lynch缝合治疗,5例接受子宫次全切治疗.术后12个月,采用Otson婚姻质量调查问卷、健康调查简易量表对其生存质量进行评价.结果介入治疗起效时间最短仅为(5.3±1.5)min,药物治疗起效时间最长为(14.8±3.2)min(P<0.01),治疗成功率方面以介入和子宫次全切最高100%(P<0.05),其他3组差异无统计学意义(P<0.05),术后并发症方面以子宫次全切术和宫腔填塞最高(P<0.05),其他3组差异无统计学意义(P>0.05);术后12个月,子宫次全切患者在婚姻质量和生活质量方面显著低于其他干预措施(P<0.01),其次是接受B-Lynch缝合术的患者(P<0.05),接受药物治疗和介入治疗的患者普遍生存质量较高(P<0.05),但各组患者在社会功能方面差异无统计学意义(P>0.05).结论各项干预措施具有不同特点和临床效果,应根据临床适应症合理选择,其中子宫切除术对患者术后生存质量影响较大,应慎重选择.

Objective To investigate the effect of different interventions in treating patients with intractable postpartum hemorrhage and its influence on quality of life. Methods The data of 55 patients with intractable postpartum hemorrhage were retrospective analyzed. Among them, 9 cases were successfully treated by medicine, 15 cases by interventional embolization, 14 cases by gauze packing, 12 cases by B-Lynch suture and 5 cases by subtotal hysterectomy. Their quality of life was surveyed after 12 month of treatment. Results The shortest and longest of onset time was （5.3 _＋ 1.5） min and （14.8 _＋ 3.2） rain by interventional embolization and medicine, respectively （P 〈 0.01） . The treatment success rate by interventional embolization and subtotal hysterectomy was highest （ 100% ） , and there was no significant difference between other three groups （ P 〉 0.05） The complication rate of subtotal hysterectomy and gauze packing was highest （P 〈 0.05） , and there was no significant difference between other three groups （P 〉 0.05） . 12 months after surgery, the life and marital quality of subtotal hysterectomy group was lowest, and followed by B-Lynch suture （P 〈 0.05） . Patients treated by medicine and interventional embolization got a better life （P 〈 0.05） . Conclusion Each intervention has its virtue and effect, and reasonable choice should be based on clinical indications. However, hysterectomy has a significant impact on the quality of patients life and should be chosen carefully.