瘢痕子宫再次剖宫产术后出血相关因素分析

Analysis of related factors of bleeding of uterine scar again after cesarean section

目的：研究瘢痕子宫再次剖宫产术后出血的相关因素，可供同行切磋。方法回顾性分析650例瘢痕子宫再次剖宫产术患者的临床资料，分析术后出血的相关情况，根据出血原因，将患者分为胎盘组6例，切口裂开组7例，宫缩乏力组17例，探讨术后出血相关因素。结果胎盘组术中出血量（2500±500）mL，高于宫缩乏力组（1300±400）mL 及切口裂开组（700±200）mL，宫缩乏力组术中出血量高于切口裂伤组（t ＝10．29、5．56、4．33，P ＜0．05）；宫缩乏力组术后出血量（100．09±36．45）mL，高于胎盘组（90．71±20．31）及切口裂开组（81．23±30．34）mL，胎盘组术后出血量较切口裂开组更多（t ＝3．94、3．02、2．78，P ＜0．05）；胎盘组，4例子宫切除，3例保守手术，宫缩乏力组，1例子宫切除，16例保守治疗，切口裂开组，均行保守治疗。结论胎盘因素、宫缩乏力、切口裂开均有可能导致瘢痕子宫再次剖宫产术后出血，临床应也加强防范工作，积极采取相关应对措施，减少术后出血风险，确保母婴生命安全。

Objective To study the related factors of hemorrhage of uterine scar again after cesarean section,available for peer exchange.Methods A retrospective analysis of clinical data of 650 patients with scar uterus again cesarean section patients,analysis of postoperative hemorrhage patients,the causes of bleeding.They were divided into placental group （n =6）,incision dehiscence group （n =7）,uterine atony group （n =17）according to the causes of hemorrhage,and related factors of postoperative bleeding were analyzed.Results The bleeding volume of the placental group in operation[（2 500 ±500）mL]was higher than the uterine atony group[（1 300 ±400）mL] and the incision dehiscence group[（700 ±200）mL].The bleeding volume of the uterine atony group was higher than the incision dehiscence group （t =10.29,5.56,4.33,all P 〈0.05）.The bleeding volume of the uterine atony group after operation[（100.09 ±36.45）mL]was higher than the placental group[（90.71 ±20.31）mL]and the uterine atony group[（81.23 ±30.34）mL].The bleeding volume of the placental group after operation were higher than the uterine atony group （t =3.94,3.02,2.78,all P 〈0.05）.4 cases of hysterectomy,3 cases of conservative surgery in placental group.1 case of hysterectomy,16 cases of conservative surgery in uterine atony group.7 cases conservative surgery in incision dehiscence group.Conclusion placental factors,uterine atony,incision dehiscence all can lead to scar uterus again cesarean section hemorrhage.We should also strengthen the clinical prevention work,and actively take relevant measures,reduce postoperative bleeding risk,to ensure the safety of the mother and infant.