产后出血急症子宫切除术46例临床资料分析

Clinical analysis of 46 cases on emergency hysterectomy for postpartum hemorrhage

目的探讨难治性产后出血急症子宫切除术的原因、抢救难治性产后出血中的手术时机及孕产妇结局，为预防和处理产后大出血提供依据。方法采用回顾性研究方法对2010年至2014年在西北妇女儿童医院分娩的46例因产后出血行急症子宫切除术患者的临床资料进行分析。结果5年间共住院分娩56436例，有582例发生了产后出血，产后出血发生率1．03％；其中46例患者经保守治疗出血仍不能控制，实施了急症子宫切除术。产后出血原因为：胎盘因素（43．48％，20／46），宫缩乏力（36．96％，17／46），胎盘因素合并宫缩乏力（10．87％，5／46），羊水栓塞（4．35％，2／46）和晚期产后出血感染（4．35％，2／46）。出血量1500～4000ml，平均（2783±625）ml。46例患者均行急症子宫切除术后痊愈出院。结论急症子宫切除术是产后大出血经保守治疗无效时抢救孕产妇生命的有效措施，胎盘因素是急诊子宫切除的主要原因，做好产后出血的预防与处理可以有效地降低围生期子宫切除率。

Objective To explore the risk factors and the time of hysterectomy for intractable postpartum hemorrhage. Methods A retrospective analysis was performed on 46 cases of emergency hysterectomy for postpartum hemorrhage, who were admitted to our hospital between January 2010 and December 2014. Results During five years, there were total 56436 delivery cases and 582 cases of postpartum hemorrhage in our hospital. The incidence rate of postpartum hemorrhage was 1.03%. 46 cases were processed emergency hysterectomy due to inefficient conservative theatments. The causes of postpartum hemorrhage incuded placenta factors （ 43.48% , 20/46 ） , uterine atony （ 36. 96%, 17/47 ）, uterine atony with placenta factors （ 10. 87% , 5/46 ）, amnionic fluid embolism （ 4. 35% , 2/46 ）, and late postpartum hemorrhage（4. 35% ,2/46）. Range of blood loss was 1 500 -4 000 ml. The average of blood loss was 2855±500 ml. All of 46 patients were recovered. Conclusions Emergency hysterectomy is effective treatment for severe postpartum hemorrhage with inefficient conservative theatments. Placenta factors is the main cause of emergency hysterectomy. We should take effective measures in prevention and treatment of postpartum hemorrhage in order to reduce the occurrence rate of hysterectomy.