保守手术及护理干预剖宫产严重产后出血的效果

Observation on Conservative Hemostatic Surgeries Combined with the Comprehensive Nursing to Control Severe Postpartum Hemorrhage in Cesarean Section

目的探讨宫腔填塞、改良子宫捆扎术及综合护理干预剖宫产术中严重产后出血的效果。方法将116例剖宫产严重产后出血患者随机分为改良子宫捆扎术组(n=57),宫腔填纱术组(n=59),术后个体化综合护理,比较两组手术操作时间、术中出血量、术后出血量、止血成功率、子宫切除率、及产褥期并发症发生率。结果捆扎组与填塞组止血成功率、术后24 h出血量、子宫切除率、并发症发生率分别为88.1/89.5、254/206、3.4/3.5、1.7/1.8,P>0.05;捆扎组手术操作时间、术中出血量明显少于填纱组(15.1/26.3、367/534,P<0.05)。结论两种保守性手术结合综合护理对控制剖宫产术严重产后出血均有良好效果,并发症少,捆扎术具有术中出血少、操作时间短优势;填纱术易掌握、对子宫无创,易于基层医院推广。

Objective To investigate the efficacy of different hemostatic surgeries combined with the comprehensive nursing to control severe postpartum hemorrhage（sPPH）in cesarean section.Methods 116 cases with（sPPH）during cesarean section in our hospital from Jan.2010 to Jan.2014 were randomly divided into uterine compression sutures group（57 cases）and uterine gauze packing group（59 cases）,Meanwhile using individualized comprehensive nursing.The intraoperating blood loss,operating time,hemostatic success rate and puerperal complication rate were compared between two groups.Result There were no significant differences of hemostatic success rate,post-operating blood loss,hysterectomy rate,complication rate between two groups（88.1/89.5、254/206、3.4/3.5、1.7/1.8,P〈0.05）.The operating time,intraoperating blood loss in uterine compression sutures group were significantly lower than those（15.1/26.3、367/534,P〈0.05）in uterine gauze packing group.Conclusion Two kinds of hemostatic method combined with the comprehensive nursing all have good hemostatic effect,lower complication rate.but uterine compression sutures has comparative advantage of less operating blood loss,shorter operating time.For uterine gauze packing,simpler operation,safety,noninvasive for uterus and easy in basic hospital.