宫腔球囊联合欣母沛在前置胎盘剖宫产术中止血的临床观察

Hemostasis of bakri balloon tamponade combined with hemabate during cesarean delivery for placenta previa

目的评估宫腔Bakri球囊压迫止血联合欣母沛针于胎盘附着部位多点注射在前置胎盘剖宫产术中止血的有效性。方法分析嘉兴市妇幼保健院2011年4月—2013年4月收治的前置胎盘剖宫产术中出血量500 ml以上的患者46例,胎儿娩出后立即预防采用欣母沛针250μg用生理盐水稀释后,于子宫下段出血部位局部多点注射,如仍有活动性出血则联合宫腔填塞Bakri球囊以压迫子宫下段出血部位达到快速止血目的。结果研究组术中术后2 h、24 h出血量均明显少于对照组,差异有统计学意义(P<0.05),研究组输血患者比例为8.7%(4/46),明显少于对照组的26.1%(12/46),差异有统计学意义(P<0.05),2组产妇术中和术后不良反应总发生率比较差异无统计学意义(P>0.05)。结论前置胎盘剖宫产术中出血时应用欣母沛多点注射配合宫腔填塞球囊能有效迅速控制出血,方法简便,易于掌握,值得临床推广应用。

Objective To assess the hemostasis effectiveness of the intrauterine Bakri balloon tamponade combined with Hemabate multi-site injection into the sites of placental attachment in uterus during the cesarean delivery for placenta previa. Methods The clinical data of 92 cases of cesarean delivery for placenta previa with peroperative bleeding loss over500 ml from April 2011 to April 2013 in our hospital were analyzed. They were divided into control group and experimental group,the control received the conventional hemostatic therapy,while the experimental group received the 250 μg Hemabate multi-site injections into the bleeding sites of placental attachment in uterus,and Bakri balloon tamponade was followed when active bleeding was found. Results The bleeding loss during the operation,and 2h and 24 h after the operation in the experimental group was significantly less than that in the control group,the difference was statistically significant（ P〈0. 05）; There were 4（ 2. 7%） blood transfusion patients in the experimental group（ 4 /46）,which was significantly less than the 26. 1% of the control group（ 12 /46）,and the difference was（ P〈0. 05）. There was no statistically significant in the difference in the overall incidence of intraoperative and postoperative adverse reactions between the two groups（ P〉0. 05）. Conclusion The intrauterine Bakri balloon tamponade combined with Hemabate multi-site injection during the cesarean delivery for placenta previa can effectively control the bleeding,and the method is simple and easy to master,worthy of clinical application.