剖宫产中子宫下段环形缝扎术与动脉栓塞镶嵌式治疗前置胎盘产后出血的随机对照研究

Randomized control study on the treatment of postpartum hemorrhage with placenta and placenta by loop suture of lower uterine segment in cesarean section

目的探讨剖宫产中子宫下段环形缝扎术与动脉栓塞镶嵌式治疗前置胎盘产后出血的临床疗效及安全性。方法选取108例前置胎盘剖宫产者，按随机数字表法分为对照组及研究组，各54例。对照组予子宫下段环形缝扎术，研究组予动脉栓塞镶嵌式。比较两组术前术后血压、脉搏、血氧饱和度的变化，以及术中、术后情况及并发症发生率，评估临床疗效及安全性。结果两组术前术后收缩压、舒张压、脉搏、血氧饱和度平稳，同组术前、术后间比较差异均无统计学意义（P〉0．05），两组术后同期间比较差异均无统计学意义（P〉0．05）；对照组剖宫产术中出血量[（2134．75±189．63）ml]高于研究组[（1864．82±201．33）ml]（P〈0．05）；两组1分钟Apgar评分、子宫切除率比较差异均无统计学意义（P〉0．05）；对照组术后24h出血量[（306．75±151．33）ml]高于研究组[（249．34±160．28）ml]（P〈0．05）；两组术后抗生素使用时间比较差异无统计学意义（P〉0．05）；对照组住院费用[（3．06±1．27）万元]低于研究组[（3．62±1．35）万元]（P〈0．05）。两组休克、弥散性血管内凝血（DIC）、术后发热、术后感染发生率比较差异均无统计学意义（P〉0．05）。结论剖宫产中子宫下段环形缝扎术与动脉栓塞镶嵌式治疗前置胎盘产后出血临床疗效显著，安全可靠；其中动脉栓塞镶嵌式能有效减少剖宫产术中出血量及术后24h出血量，而子宫下段环形缝扎术更经济。

Objective To explore the clinical efficacy and safety of loop suture ligation and arterial embolization in the treatment of postpartum hemorrhage caused by placenta placenta. Methods A total of 108 cases of cesarean section was divided with digital random method into control and study groups with 54 cases in each group. The patients in the control group were given the ring suture in the lower part of the ute- rus. The changes of blood pressure, pulse, and blood oxygen saturation before and after operation were com- pared. The clinical efficacy and safety were evaluated between two groups. Results Pressure, diastolic blood pressure, pulse and blood oxygen saturation of two groups were stable before and after contraction, the difference with two group before and after operation were not statistically significant （ P 〉 0. 05 ）, and two groups after operation during the same period, the difference was not statistically significant （ P 〉 0. 05 ）. Cesarean section bleeding in the control group [ （2 134. 75 ± 189. 63）ml] was higher than the study group [ （1 864. 82 ±201.33）ml] （P 〈0. 05）, and Apgar score at 1 min and hysterectomy rate differences were not statistically significant between two groups （ P 〉 0. 05 ）. The control group 24 h postoperative bleeding [ （306. 75 ± 151.33 ）ml] was higher than the study group [ （249.34 ± 160. 28）ml ] （P 〈 0. 05 ）, and two groups of postoperative antibiotic use time differences were not statistically significant （ P 〉 0. 05 ）. Hospi- talization expenses control group [ （ 3.06 ± 1.27） ten thousand yuan ] were lower than the study group [ （3.62 ± 1.35）ten thousand yuan] （P 〈0. 05）. Shock rate was 31.5% in the control group, and study group 24. 1%. The incidence rate of disseminated intravascular coagulation （D/C） was 14. 8% in the control group, and study group 11.1%. Postoperative fever incidence rate was 44. 4% in the control group, and study group 42. 6%. Incidenee of postoperative infection was 24. 1% in control group, and study group 18.5%. Shock rate, DIC rate, and postoperative fever incidence were not significant difference between two groups （ P 〉 0. 05 ）. Conclusions The cesarean section in the lower uterine segment eircumsuture and arterial embolization treatment of postpartum hemorrhage had clinical curative effect, safe and reliable. The arterial embolization mosaic can effectively reduce the cesarean section bleeding and postoperative bleeding 24 h, while the lower uterine segment circumsuture was more economical.