止血带捆扎子宫峡部干预胎盘因素诱发产后出血的效果观察

Observation of the effects of postpartum hemorrhage induced by tourniquet strapping uterine isthmus intervening placenta

目的观察胎盘因素诱发产后出血给予子宫峡部止血带捆扎的干预效果。方法回顾性分析本院产科2010年3月至2014年8月行剖宫产术的胎盘异常且术中发生产后出血的110例产妇的临床资料,依据术中是否使用止血带捆扎止血分为对照组与研究组,每组各55例。对照组患者剖宫产术中未使用弹性止血带,研究组患者在胎儿娩出后行子宫峡部止血带环形捆扎止血。对比两组患者手术时间、术中出血量、输血率、子宫切除率、术后24小时出血量、产后出血发生率、住院时间。随访6个月,统计两组患者并发症发生情况及预后。结果研究组患者手术时间明显长于对照组(P<0.05),术中出血量及输血率均显著低于对照组(P<0.05)。两组患者子宫切除率比较差异无显著性(P>0.05)。研究组患者术后24小时出血量、产后出血发生率及住院时间均显著低于对照组(P<0.05)。两组患者并发症发生率比较差异无显著性(χ2=0.10,P>0.05)。所有患者均未失访,随访期内月经周期均恢复正常,且无显著月经失调发生。结论胎盘因素诱发产后出血给予子宫峡部止血带捆扎虽显著延长了手术时间,但极大地遏制了产后出血,显著减少输血量,促进患者术后恢复。

Objective To observe the effects of postpartum hemorrhage induced by tourniquet strapping uterine isthmus intervening placenta.Method Clinical data of 110 puerpera in our hospital obstetrics from March 2010 to August 2014 were retrospectively analyzed.These puerpera had cesarean section delivery and postpartum hemorrhage induced by placental abnormality.They were divided into control group and study group according to the tourniquet strapping usage condition,55 cases in each group.Puerpera in control group were not given any elastic tourniquets during the cesarean section,while puerpera in study group were given tourniquet strapping uterine isthmus after delivery.The operation time,amount of bleeding during the operation,blood transfusion rate,hysterectomy rate,amount of bleeding in 24 hours after operation,postpartum hemorrhage incident rate and length of stay were compared between the two groups.All puerpera were followed up for six months and their complications incident condition and the prognosis were summed up.Result The operation time of study group was obviously longer than control group,the amount of bleeding during the operation and blood transfusion rate were obviously lower than control group（P〈0.05）.There was no significant difference in hysterectomy rate between the two groups（P〉0.05）.The amount of bleeding in 24 hours after operation,postpartum hemorrhage incident rate and length of stay in study group were obviously longer than control group（P〈0.05）.There was no significant difference of complications incident rate between the two groups（χ^2= 0.10,P〉0.05）.All puerpera had normal menstrual cycle during the follow-up visit period and no menstrual disorder cases were found.Conclusion Postpartum hemorrhage induced by placenta factors and tourniquet strapping uterine isthmus can lengthen the operation time,it canstop the postpartum hemorrhage to a great extent,and significantly decrease the amount of blood transfusion and help the patients＇ rehabilitation.