剖宫产术中止血方法的回顾性分析

Retrospective analysis of hemostatic methods during cesarean section

目的探讨各种手术治疗剖宫产术中出血的止血方法，提高产后出血的救治能力。方法回顾性分析我院2010年1月至2014年7月分娩的31833份病历，以年份及手术治疗的止血方法来分组。以2010年1月至2012年12月在我院分娩的19845位产妇为对照组，2013年1月至2014年7月在我院分娩的11988位产妇为研究组。研究两组产后出血率、子宫切除率及Blyneh缝合术、子宫动脉上行支结扎术、宫腔放置Bakri球囊等各种手术治疗止血方法的使用率。结果①研究组中剖宫产率明显高于对照组，但产后出血率明显低于对照组（χ2=35．62，P=0．000），子宫切除率也有所下降；②剖宫产术中行Bakri球囊处理后出血量最少（113±171）ml，行子宫动脉上行支结扎处理后出血量最多（299±146）ml，各组比较差异均有统计学意义。结论剖宫产术中出血，应在行药物治疗的同时，根据术中子宫出血的不同情况，相应的行Blyneh缝合术、子宫动脉上行支结扎术、宫腔放置球囊术或者几种止血方法联合应用，来减少产后出血，降低产后出血的发生率，提高产后出血的救治能力。

Objective To explore the operative hemostatic methods during cesarean section and to improve the ability treating postpartum hemorrhage. Methods 31,833 patient records from our hospital from January, 2010 and July, 2014 were retrospectively analyzed and were grouped in terms of therapeutic methods and delivery time. 19, 845 women who delivered at our hospital from January, 2010 to December, 2012 were set as a control group, and 11,988 women who delivered at our hospital from January, 2013 to July, 2014 a study group. The rate of postpartum hemorrhage, the rate of uterus resection, and the usage rates of Blynch operation, uterine artery ascending branch ligation, and Bakri balloon in both groups were studied. Results The cesarean delivery rate was significantly higher, but the postpartum hemorrhage rate was significantly lower in the study group than in the control group （χ2=35.62, P=0.000）, and the uterus resection rate also declined fell in the study group. Treating hemorrhage during cesarean section with Bakri balloon was most effective, with a lowest bleeding volume of （113 ±171） ml, and with uterine artery ligation least effective, with a highest bleeding volume of （299 ±146） ml. Conclusions Hemorrhage during cesarean section should be treated with medication, at the same time, according to the different situation of intraoperative bleeding, Blynch operation, uterine artery ascending branch ligation Bakri balloon, or combination of several hemostatic methods should be applied, to reduce postpartum hemorrhage, decrease the incidence of postpartum hemorrhage, and improve the treatment ability for postpartum hemorrhage.