子宫填塞球囊导管治疗产后出血42例失败分析

Failure analysis of uterine balloon catheter tamponade for postpartum hemorrhage in 42 cases

目的探讨子宫填塞球囊导管(Bakri球囊)治疗产后出血的效果以及影响治疗效果的原因。方法对2010年6月至2013年12月在郑州大学第二附属医院因产后出血而行Bakri球囊治疗的370例患者进行回顾性分析,根据临床止血情况将患者分为治疗成功组和治疗失败组,比较两组患者临床治疗效果和手术指标的区别。结果与治疗成功组相比,失败组的产妇年龄较大(35.20±5.22岁vs 31.61±3.72岁,t:-7.81,P<0.05)、孕产次较多(2.71±1.19次vs 2.01±1.06次,t=-3.76,P<0.05)、球囊注水量较多(385.16±72.36mL vs 268.04±70.85m1L,t=-7.29,P<0.05)、产后血红蛋白水平较低(83.34±7.33/L vs 91.21±6.82/L,t=6.61,P<0.05)、产后出血量较多(1 564.27±97.6mL vs 809.32±105.6nL,t=-33.33,P<0.05)、胎盘植入和瘢痕子宫的发生率较高(35.71%vs 1.52%;45.24%vs 2.13%,Fisher确切概率法均P<0.05)。两组在孕周、产前血红蛋白水平、放置球囊前出血量、放置Bakri球囊的操作时间方面比较差异均无统计学意义(t值分别为0.62、-0.08、-1.80、0.58,均P>0.05)。结论 Bakri球囊压迫是产后出血有效、安全、简便的治疗方式,但对高龄产妇或胎盘植入、瘢痕子宫产妇会影响治疗效果。

Objective To investigate the effect of uterine balloon catheter （Bakri balloon） tamponade on the treatment of postpartum hemorrhage and the reasons for failure.Methods From June 2011 to December 2013 370 cases undergoing Bakri treatment in Second Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Patients were divided into successful group and failed group according to condition of hemostasis.The clinical efficacy and surgical indexes were compared between two groups.Results Compared with the successful group, patients in the failed group was older （35.20 ±5.22 years vs 31.61 ±3.72 years, t=-7.81, P〈0.05）, had more gravidities （2.71 ±1.19 times vs 2.01 ±1.06 times, t=-3.76,P〈0.05）, was injected more balloon water （385.16 ±72.36 ml vs 268.04 ±70.85ml, t=-7.29, P〈0.05）, had lower level of hemoglobin （83.34 ±7.33g/L vs 91.21 ±6.82g/L, t=6.61,P〈0.05）, had more postoperative bleeding （1 564.27 ±97.6 mL vs 809.32 ±105.6mL, t=-33.33,P〈0.05）, and had higher incidences of placenta increta and uterine scar （35.71%vs 1.52%;45.24%vs 2.13%,P〈0.05）.There were no significant differences between two groups in gestational age, prenatal hemoglobin levels, bleeding before balloon placing, operating time for putting Bakri balloon （ t value was 0.62, -0.08, -1.80 and 0.58, respectively, all P〉0.05） .Conclusion Bakri balloon pressure is effective, safe and simple treatment for postpartum hemorrhage.However, failure should be considered in older puerperas with placenta increta or uterine scar.