产科弥漫性血管内凝血28例临床分析

Clinical analysis of 28 cases with obstetric disseminated intravascular coagulation

目的：探讨产科弥漫性血管内凝血的发生原因、治疗方案及其预后的影响因素。方法选择2006年1月~2014年1月在我院妇产科收治的28例发生弥漫性血管内凝血的孕妇作为本次临床观察的研究对象，回顾性分析孕妇发生弥漫性血管内凝血的原因及其临床表现，探讨弥漫性血管内凝血的临床治疗效果。结果28例孕妇均抢救成功，无产妇死亡病例；子宫全切除的患者有3例，次全子宫切除患者1例，子宫动脉灌注栓塞术患者6例。胎儿情况，新生儿存活27例，宫内死亡1例，死胎4例，新生儿死亡率为15.62%。患者在弥漫性血管内凝血治疗前后，凝血功能有明显区别。在治疗后，患者的凝血功能有着明显改善。结论弥漫性血管内凝血的治疗主要是及时并且有效地将引起弥漫性血管内凝血的病因去除，同时进行有效的止血、补充血容量等相关的对症治疗。子宫动脉灌注栓塞术及再次开腹探查时加行B-Lynch子宫缝扎术，对保留子宫起了非常重要的作用。

Objective To explore the cause, treatment programs and prognostic factors of obstetric disseminated intravascular coagulation. Methods 28 pregnant women with disseminated intravascular coagulation in our hospital from January 2006 to January 2014 were selected, the cause and clinical manifestations of the pregnant women with disseminated intravascular coagulation were retrospectively analyzed. Results 28 pregnant women were all rescued successfully, no maternal deaths;3 cases had total hysterectomy, 1 case had subtotal hysterectomy, 6 cases had uterine arterial embolization. Fetal condition, 27 neonatal survived, 1 case was intrauterine death, 4 cases were stillbirth, neonatal mortality rate was 15.62%. Patients＇ coagulation function had significant differences before and after the treatment of disseminated intravascular coagulation. After the treatment, patients＇ coagulation function had been significantly improved. Conclusion In the treatment of disseminated intravascular coagulation, it is main to remove the cause of disseminated intravascular coagulation, while to give effective hemostasis, add volume and other related symptomatic treatment. It plays a very important role for reservations uterus of uterine arterial embolization and plus line B-Lynch suture uterus when Laparotomy again.