Bakri球囊治疗产后出血的临床效果

Role of Bakri balloon in management of postpartum haemorrhage

目的比较Bakri球囊填塞与纱布宫腔填塞治疗产后出血的临床效果。方法收集2013年1月1日至2014年7月31日金华市中心医院收治的因宫缩乏力或胎盘因素产后出血患者34例,分为Bakri球囊组20例和宫腔填纱组14例,观察两组的年龄、孕周、手术操作时间、放置前出血量、放置后2h出血量、放置后24h出血量、止血所需时间,进一步分析放置Bakri球囊患者的病例特点。结果 Bakri球囊组手术操作完成时间明显短于宫腔填纱组(t=22.939,P<0.01),Bakri球囊组止血所需时间也短于宫腔填纱组(t=23.341,P<0.01),而两组在年龄、孕周、放置前出血量、放置后2小时出血量、放置后24小时出血量方面比较差异均无统计学意义(t值分别为0.565、0.035、-0.986、-0.808、-0.285,均P>0.05)。Bakri球囊治疗产后出血20例,其中5例合并有前置胎盘,2例患者放置球囊后采取后续侵入性治疗,所有患者术后恢复良好,无明显疼痛,无发热,无死亡病例。结论 Bakri球囊能够治疗产后出血,操作简单,疗效肯定,并不增加术后病率。球囊放置后应加强监护,对于治疗无效者应尽早采取更积极的治疗方法。合并有高龄、妊娠期高血压疾病可能是影响放置成功率的因素。

Objective To compare the clinical effect of Bakri balloon and gauze packing for postpartum hemorrhage （PPH）. Methods Thirty-four selected cases of PPH due to uterine inertia or placenta factors were treated in Jinhua Municipal Central Hospital during January 1st, 2013 to July 31st, 2014. They were divided into Bakri balloon group （20 cases） and ganze packing group （14 cases）. Indicators of age, gestational week, surgery duration, bleeding volume before placement, bleeding volume 2h after placement, bleeding volume 24h after placement and haemostasis were observed for two groups, and clinical characteristics of patients with Bakri balloon were further analyzed. Results The operative duration and hemostatic time in the Bakri balloon group were significantly shorter than in gauze packing group （t value was 22. 939 and 23. 341, respectively, both P 〈 0.05 ）. Age, gestational week, bleeding volume before placement, bleeding volume 2h after placement, bleeding volume 24h after placement were not significantly different between two groups （t value was O. 565, O. 035, - 0. 986, - 0. 808 and - 0. 285, respectively, both P 〉 O. 05）. Twenty cases were managed with Bakri balloon, among whom five were complicated with placenta previa and two cases accepted a seconday invasive treatment. No patient experienced postpartum abdominal pain or fever. No case died. Conclusion Bakri balloon tamponade is effective and safe in the management of PPH, and postoperative mortality will not increase. Patients should be carefully monitored after the placement of Bakri balloon, and more positive therarpy needs to be provided for uneffective patients. Elderly parturient women and gestational hypertension disease may impact the success of Bakri balloon placement.