前置胎盘剖宫产术中预防出血的处理

Prevention of Hemorrhage in Placenta Previa Cesarean Section

目的:探讨前置胎盘术中用止血带环扎子宫下段以减少出血,增强手术视野暴露的疗效。方法:46例前置胎盘并行剖宫产术患者随机分为两组,两组按常规进行手术,对照组不用止血带止血,而观察组用止血带环扎于子宫下段手术切口下缘处徒手剥离胎盘,清理胎盘附着面处异常组织,创面止血。观察两组术中出血量、输血量、输液量、手术时间、子宫切除率,术后第2天复查血红蛋白情况,术后感染率等情况。结果:观察组术中出血量、术后血红蛋白减少幅度、术后感染率明显低于对照组,差异有统计学意义(P<0.05)。结论:在前置胎盘术中用止血带捆绑子宫下段止血,能减少术中出血量,保持术野清晰,为缩短手术时间,减少术后感染率等提供行之有效的措施。

Objective： To probe into using tourniquet cerclage in lower uterine segment in the cesarean section of placenta previa in order to reduce bleeding and enhance the curative effect of surgical field exposure. Methods： 46 patients with placenta previa who had cesarean section were randomly divided into two groups. The two groups were operated by routine; the control group was operated without tourniquets,while the observation group with a tourniquet cerclage in edge of operative incision of lower uterine segment. The placenta of the observation group was unarmedly stripped; the abnormal tissue of placenta adherent surface was cleaned up and the hemostasis of the wound surface was done. The intraoperative blood loss,amount of blood transfusion,infusion volume,operation time,the rate of uterus resection,review of the hemoglobin 2 days after operation,and postoperative infectivity etc were observed. Result： The observation group had less intraoperative blood loss,significantly reduced postoperative hemoglobin and significantly lowered postoperative infection rate comparing with the control group. There was statistically significant difference（ P 0. 05）. Conclusion： Using tourniquet bundles of lower uterine segment in placenta previa surgery for hemostasis,can effectively reduce the intraoperative blood loss and keep a clear operational vision,which provides effective methods to shorten the operation time and reduce the postoperative infectivity.