产科子宫切除术治疗产科出血的研究

Study on the Treatment of Obstetric Hemorrhage Obstetric Hysterectomy

目的探讨产科子宫切除术针对产科出血的临床价值,分析降低其的可行性。方法选择于2008年6月~2014年12月于我院就诊收治的行子宫切除术应对产科出血治疗的40例病患资料进行回顾性分析。结果胎盘早剥、胎盘前置及胎盘植入等相关胎盘原因作为子宫次全切除或全切除的主要治疗指征,其他相关指征还包括子宫切口感染、子宫破裂、子宫收缩力缺乏等。40例行子宫切除术应对产科出血治疗的孕产妇出血量在355~6 800 ml,40例产妇中出血量大于1 000 ml的共计28例,在行子宫切除术给予产科出血治疗的相关并发症中,失血性休克占到大多数。其余分别是阔韧带血肿出血、盆腔腹膜炎、膀胱阴道瘘、MODS、DIC。发生死亡的有四例,四例死亡病例中失血性休克的两例,多器官功能衰竭的一例,发生DIC的一例。40例孕产妇中发生新生儿死亡的三例,出现死胎的两例,死产的两例。结论要降低产科出血时应用子宫切除术的发生率,要对相关手术指征严格把握,还要及早的发现各种手术指征相关胎盘因素,同时积极宣教围产期的相关知识,才能有效降低产后出血发生率。

Objective To investigate the clinical value of hysterectomy for obstetric hemorrhage, reduce its feasibility analysis. Methods From June 2008 to December 2014 in our hospital were treated with hysterectomy in obstetric hemorrhage treatment of 40 cases of patients were retrospectively analyzed. Results Placental abruption, placenta previa placenta and placenta implantation related reasons as hysterectomy or subtotal resection of the main indications for treatment, other related indications include uterine incision infection, rupture of uterus, uterine contraction deficiency etc.. 40 cases underwent hysterectomy with obstetric hemorrhage treatment of maternal bleeding 355 to 6800 ml, the amount of bleeding in 40 cases of more than 1 000 ml of a total of 28 cases of hysterectomy, at given treatment of complications related to obstetric hemorrhage, hemorrhagic shock accounted for the majority. The rest are broad ligament hematoma bleeding, pelvic peritonitis, vesicovaginal fistula, MODS, DIC. The deaths occurred in four cases, four cases died of hemorrhagic shock in two cases, one case of multiple organ failure, a case of DIC. Three cases of neonatal death occurred in forty cases, two cases of stillbirth, two cases of stillbirth. Conclusion To reduce the incidence of obstetric hemorrhage by hysterectomy, to the relevant operation indication strictly, but also discover various operation indications related to placental factors, while positive education related knowledge of perinatal, can effectively reduce the incidence of postpartum hemorrhage.