剖宫产产后出血246例临床分析

Analysis of 246 Cases Postpartum Hemorrhage in Cesarean Section

目的探讨剖宫产产后出血原因、出血量、输血量变化及治疗方法进展。方法相隔10年收集我院两个时间段的所有剖宫产产后出血病例,回顾性分析2001年1月至2002年12月两年间95例剖宫产产后出血病例(A组)和2011年1月至12月1年内的151例剖宫产产后出血病例(B组)临床资料。结果剖宫产产后出血前3位原因没有变化。A组和B组产时出血量分别为(935.8±863.1)、(520.4±350)mL,有统计学差异(P<0.05)。产后2 h内出血量分别为(32.6±163.2)、(36.5±186.0)mL,无统计学差异(P=0.43),A组和B组产后24 h总出血量分别为(1006.3±876.0)、(817.6±419.1)mL,有统计学差异(P<0.05)。A组32例出血>1000 mL,B组29例出血>1000 mL,有统计学差异(P=0.01)。A组58例输血,平均输血量(815.5±612.1)mL;B组50例输血,平均输血量(665.8±501.3)mL,有统计学差异(P<0.05)。产后出血基本处理方法仍旧是按摩子宫、应用缩宫素等,其他药物10年前应用麦角较多,10年后应用欣母沛和益母草针比例较高,且开展了子宫动脉栓塞治疗及子宫缝合方法的改进。A组子宫全切1例,次全切3例,B组1例子宫全切。结论 10年来剖宫产产后出血原因无明显变化,治疗取得了很大进展,产科手术质量提高,新药使用等显著减少了剖宫产产后出血量,减少了输血量,子宫切除病例明显减少。

Objective To analysis Changes on factors associated with postpartum hemorrhage in cesarean section, the volume of bleeding and blood transfusion and progress of treatment. Method Collected cases of two time periods in our hospital on postpartum hemorrhage in cesarean section during 10 years, Retrospective analysis clinical data, 95 cases of postpartum hemorrhage cases from January 2001 to December 2002 （group A ）and 151 cases of postpartum hemorrhage cases from January 2011 to December （group B）. Result The first three postpartum hemorrhage related factors did not change. the volume of bleeding during partum in two group was （935.8±863.1） mL, （520.4±350） mL respectively, significant differences （P〈 0.05）. Within 2 hours postpartum, the volume of bleeding was （32.6±163.2） mL, （36.5±186.0） mL, no significant difference （P=-0.43）, the 24 hours post-partum bleeding volume was （1006.3±876.0） mL, （817.6±419.1） mL, significant differences （P〈0.05）. 32 cases in group A, bleeding more than 1000 mL, accounting for 33.7%, 29 cases in Group B bleeding more than 1000 mL,accounting for 19.2%, significantly different （P =0.01）.in group A, 58 cases need transfusions, accounting for 61.1%, the average amount of blood transfusion （815.5±612.1） mL;50 cases need transfusions, accounting for 33.1%, the average amount of blood transfusion （665.8±501.3） mL,significantly different （P〈 0.05）. Postpartum hemorrhage basic approach is still massage the uterus, oxytocin, ect. other drugs such as Ergometrine usually used 10 years ago, while after 10 years hemabate and motherwort injection account for a higher proportion of management, during l0 years we launched uterine artery embolization and improved methods of uterine suture, there are hysterectomy one case, subtotal hysterectomy three cases in Group A, hysterectomy one case in group B. Conclusion During 10 years, the causes of postpartum hemorrhage have no significant change the treatment gets significantly improve, the improvement of obstetric surgery quality, the use of new drug, significantly reduces the volume of postpartum hemorrhage, the amount of blood transfusion and the patients need hysterectomy.