两种方法对剖宫产术中出血量评估的比较及剖宫产术中出血的原因分析

Comparison of two methods on postpartum hemorrhage assessment of cesarean and its cause analysis

目的:比较两种方法对评价剖宫产术中出血量的准确性,分析术后出血发生率及影响术中出血量的主要因素。方法:将本院需施剖宫产手术的产妇为研究对象,随机分为试验组和对照组。试验组采用联合称重、羊水血细胞比容(HCT)换算法评估剖宫产术中出血量;对照组采用目测法评估剖宫产术中出血量,同时测定产前和产后6h血红蛋白浓度、血细胞比容和血小板数量,比较两种方法估值的准确性,并分析引起出血的因素。结果:试验组产妇术中出血量为(486.18±276.35)m L,对照组产妇术中出血量为(285.23±147.04)m L,两者比较具有显著性差异(P<0.01);试验组和对照组术后6h血红蛋白浓度、血细胞比容较产前有所下降,两者比较具有统计学差异(P<0.01),血小板数量比较无统计学差异(P>0.05);试验组和对照组剖宫产产后出血发生率为41.0%和9.0%。出血原因统计结果显示子宫收缩乏力是子宫术中出血的主要原因,占总人数的63.50%。结论:目测法对评价剖宫产术中出血量具主观性和一定的误差,而联合称重法、羊水血细胞比容(HCT)换算法比目测法具有客观性和正确性。子宫收缩乏力是剖宫产产中出血的主要原因。

Objectives： To estimate and compare the amount of postpartum hemorrhage of cesarean accurately by weighty method and visual method and analyze its occurrence rate and main causes. Method： 200 maternal patients of cesarean were randomly divided into experimental and control group,weighty method was used to estimate the postpartum hemorrhage of experimental group and visual method was used to estimate the postpartum hemorrhage of control group. Hemoglobin（ Hb） and hematocrit（ HCT） were detected at antepartum and postpartum,and the factors that caused postpartum hemorrhage were analyzed. Results： The average amount of postpartum hemorrhage of experimental group was 486. 18 ± 276. 35 m L,and the average amount of postpartum hemorrhage of control group was 285. 23 ± 147. 04. There were significant differences between the two groups. There was significant differences in Hb and HCT between the experimental group and control group（ P〈 0. 01）. There was no difference in blood platelet between the two groups（ P〉 0. 05）. The incidence rate of postpartum hemorrhage of experimental and control group were 41. 0% and 9. 0%. Statistical results of causes of postpartum hemorrhage showed that uterine inertia was the main cause of uterine bleeding,63. 50% of the total. Conclusion： Visual method of postpartum hemorrhage of cesarean is more subjective. Weighty method is more objective,and it is the better way to estimate postpartum hemorrhage of cesarean. Uterine inertia is the main reason for postpartum hemorrhag.