剖宫产术中内压缩缝合法用于中央性前置胎盘264例疗效分析

Effect of inner-compression sutures of lower uterine segment during cesarean delivery on postpartum hemorrhage of patients with complete placenta previa

目的探讨剖宫产术中内压缩缝合法处置中央性前置胎盘的有效性及安全性。方法选择2010年1月至2014年12月北京市海淀区妇幼保健院剖宫产术中诊断为中央性前置胎盘的患者264例,其中82例使用内压缩缝合法止血者为研究组,182例使用非压缩缝合止血方法者为对照组,比较两组产后出血量、产后出血率、血红蛋白下降值、输血率及子宫切除率、手术时间、产褥病率和术后平均住院时间的差异。结果研究组产后出血量[(416.95±228.28)ml]显著少于对照组[(542.47±513.83)ml,(P<0.05)];研究组术后血红蛋白降低值[(10.21±12.32)g/L]显著小于对照组[(13.97±15.27)g/L,P<0.05];研究组输血率(3.66%,3/82)显著低于对照组(11.54%,21/182;P<0.05)。研究组平均手术时间[(24.57±5.73)min]少于对照组[(33.45±16.93)min,P<0.05]。两组的平均住院时间[(4.12±1.38)d和(3.93±0.95)d]比较,差异无统计学意义(P>0.05);研究组产褥病率(7.32%,6/82)显著低于对照组(16.48%,30/182;P<0.05)。两组均无邻近脏器损伤、弥散性血管内凝血及子宫切除等严重并发症。结论剖宫产术中内压缩缝合法处置中央性前置胎盘能明显减少产后出血和避免切除子宫的风险。

Objective To explore the effect and safety of inner-compression sutures in the lower uterine segment on postpartum hemorrhage control during cesarean delivery for patients with complete placenta previa.Methods 264 cases of complete placenta previa who delivered at Maternal and Child Health Hospital of Haidian District,Beijing from January 2010 to December 2014 recruited in this study.All the patients were divided into two groups：82 cases with inner-compression sutures done by the authors as the study group,and the other 182 cases with non-compression sutures as the control group.Blood loss,the rate of postpartum hemorrhage,the rate of blood transfusion,and the rate of hysterectomy were compared.Also the average length of operation,the rate of puerperal morbidity and the average postoperative hospitalization stay were compared.Results There was no statistical difference between the two groups in mean age,gestational age and birth weight.The amount of postpartum bleeding was（416.95±228.28） ml in the study group,which was significantly less than that of the control group（542.47±513.83） ml（P〈0.05）.The postoperative hemoglobin loss of study group was（10.21±12.32） g/L,which was significantly less than that of the control group（13.97±15.27） g/L（P〈0.05）.The rate of blood transfusion was 3.66%（3/82）in the study group,which was significantly less than that of the control group（P〈0.05）.There was no case of hysterectomy in the two groups.The average operation time of the study group was（24.57±5.73） min,which was significantly less than that of the control group（33.45±16.93） min（P〈0.05）.The rate of puerperal morbidity of the study group was significantly less than that of the control group（7.32% vs 16.48%）（P〈0.05）.And there was no significant difference between the two groups in the average hospitalization stay（P〉0.05）.There were no serious complications such as injury of adjacent organs,disseminated intravascular coagulation and other serious complications in the two groups.There were no hysterectomy cases in the two groups.Conclusions Inner-compression sutures in the lower uterine segment during cesarean delivery for patients with complete placenta previa can significantly reduce the rate of postpartum hemorrhage and the risk of hysterectomy.