产后出血止血方法选择及止血失败原因分析

Selection of Haemostasis Methods for Intractable Postpartum Hemorrhage and Analysis on Impact Factors of Failed Hemostasis

目的探讨产后出血不同止血方法效果及影响止血结局的因素。方法对2008年1月至2013年1月丰都县人民医院86例产后出血进行回顾性研究,所有患者按照止血方式的不同分为填塞组(23例)、结扎组(20例)、缝合组(22例)、缝合+填塞组(21例),比较不同止血方式的应用效果,分析影响产后出血治疗效果的因素。结果缝合+填塞组出血量最少为(439±102)m L,填塞组最多为(1135±231)m L;手术时间缝合组为(84±16)min、结扎组(95±13)min显著低于填塞组(132±24)min和缝合+填塞组(113±25)min。产后大出血止血失败的主要原因是宫缩乏力(OR=9.621,P<0.01)、分娩方式(OR=6.841,P<0.01)、凝血功能障碍(OR=3.094,P<0.01)。结论产后出血需根据患者实际情况选择合适的止血方法。

Objective To analyze the efficacy of different haemostasis methods for intractable postpar-tum hemorrhage and identify impact factors of failed hemostasis .Methods Clinical data of 86 patients with postpartum hemorrhage admitted in Fengdu People′s Hospital from Jan.2008 to Jan.2013 were retrospective-ly analyzed.All the cases were divided into different groups according to different haemostasis methods：stuff-ing group（23 cases）,ligation group（20 cases）,suture group（22 cases）,suture＋stuffing group（21 cases）, the effects of different haemostasis methods were compared and factors that could impact on the hemostasis outcome were analyzed.Results Intraoperative blood loss of the suture＋stuffing group[（439 ±102） mL] was significantly less than the other groups,and that of the stuffing group （1135 ±231） mL was the most. The operation time of the suture group （84 ±16） min and ligation group （95 ±13） min were significantly less than stuffing group （134 ±24） min and suture ＋stuffing group （113 ±25） min.Main risk factors of hemostasis failure in patients with postpartum hemorrhage were uterine inertia （OR =9.621,P 〈0.01）, delivery mode （OR=6.841,P〈0.01）and coagulation disorder（OR =3.094,P 〈0.01）.Conclusion Selection of haemostasis methods for patients with postpartum hemorrhage should be based on the specific sit-uation of the patients.