63例难治性产后出血转诊的临床分析

Clinical analysis of 63 cases of refractory postpartum hemorrhage undergone transfer treatment

目的总结难治性产后出血院间转诊的特点和不足,提出降低转诊风险的建议。方法 分析我院2010年1月~2015年12月收治的由外院转诊至我院的难治性产后出血病例63例,统计资料包括转诊诊断、转诊前估计出血量、入住ICU情况、孕妇结局、转诊相关文档资料等。结果 63例难治性产后出血患者主要来自二级医院,转诊用时约1~3 h,我院抢救成功58例,死亡5例,成功率92%。转诊前估计出血量〈1000 m L者21例,均保留子宫,抢救成功率100%;转诊前出血量〉1000 m L者42例,行子宫切除术24例,死亡5例,子宫切除率57%,抢救成功率88%,子宫切除率比较差异有统计学意义（χ2=19.385,P〈0.05）。转诊前循环系统稳定者48例,死亡1例,死亡率2%;循环系统不稳定者15例,死亡4例,死亡率27%,差异有统计学意义（χ2=9.453,P〈0.05）。转诊前记录完善可用于病情评估者42例,占67%,转诊途中有详细监测记录者35例,占56%。结论 基层医院估计产后出血量超过1000 m L者,应综合评估病情是否启动转诊。转诊前恰当的病情评估和积极的处理、转诊中有效止血及严密监测、转诊后启动新型的临床救治模式能提高转诊质量,降低产后出血的死亡率。

Objective To summarize the characteristics and insufficiencies of discharge and transfer treatment due to refractory postpartum hemorrhage, and propose suggestions on reducing the risk of transfer treatment. Methods 63 pa- tients with refractory postpartum hemorrhage who were admitted and transferred to our hospital from other hospitals from January 2010 to December 2015 were analyzed. The statistical data were as follows： diagnosis in the transfer treat- ment, estimated amount of bleeding before transfer treatment, ICU stay, outcome of pregnant women and relevant docu- mentation of transfer treatment. Results 63 patients with refractory postpartum hemorrhage were mainly transferred from Class Ⅱ Hospital, and the duration of transfer was approximately 1-3 hours. 58 patients were successfully rescued in our hospital, and 5 patients were deceased, with the successful rate of 92%. It was shown that 21 patients had estimat- ed amount of bleeding before transfer 〈1000 mL, with the uterus all maintained, and the successful rate of rescue was 100%. 42 patients had amount of bleeding before transfer 〉1000 mL, and 24 patients were given hysterectomy, with the rate of hysterectomy of 57%, and 5 patients were deceased, with the successful rate of rescue of 88%. The differences of rate of hysterectomy were statistically significant （X2=19.385, P〈0.05）. The circulation system of 48 patients were sta- ble before transfer, and 1 patient was deceased, with the death rate of 2%. The circulation system of 15 patients was unstable, and 4 patients were deceased, with the death rate of 27%. The differences were statistically significant （x2= 9.453,P〈0.05）. The records of 42 patients were complete before transfer and could be used for disease evaluation, ac- counting for 67%. It was shown that 35 patients had detailed monitoring records during transfer, accounting for 56%. Conclusion For the patients with the estimated amount of postpartum hemorrhage exceeding 1000 ml in the grass-root hospital, the diseases should be comprehensively evaluated so as to ensure whether transfer is initiated. Appropriate disease evaluation and active treatment, effective hemostasis and close monitoring during transfer, and implementation of new clinical rescue mode after transfer are able to improve the quality of transfer, and reduce the mortality rate of postpartum hemorrhage.