前置胎盘剖宫产术中结扎子宫动脉预防产后出血的效果分析

Effect Analysis of Uterine Arteries Ligation on Prevention of Postpartum Hemorrhage in Cesarean Section for Placenta Praevia

目的探讨子宫动脉结扎术对预防剖宫产前置胎盘产妇产后出血的临床效果。方法根据数字表法将62例前置胎盘行剖宫产术产妇随机分为对照组和观察组,每组31例。对照组产妇实施宫腔填塞纱布给予止血,观察组产妇实施子宫动脉结扎术预防产后出血,对比两组手术时间、填塞物留置时间、术中出血量、术中输血量、术后24 h出血量,对比两组产妇术后半年身体恢复情况及随访1年内的并发症发生情况。结果观察组平均手术时间、填塞物留置时间和对照组比较明显较短,术中出血量、术中输血量、术后24 h出血量和对照组比较明显较少,差异有统计学意义(P<0.05)。观察组产妇术后半年恶露排除率、月经恢复率、月经周期正常率、母乳正常分泌率和对照组比较无明显差异,无统计学意义(P>0.05)。两组产妇术后子宫及腹壁切口均能良好愈合,观察组有2例术后出现发热、对照组则有10例术后出现发热,差异具有统计学意义(P<0.05)。两组术后进行为期1年的随访,两组宫腔粘连发生率、月经改变发生率的差异无统计学意义(P>0.05)。结论前置胎盘剖宫产术产妇实施子宫动脉结扎术的临床效果确切,易于操作,对产妇术中术后的止血效果较好,明显减少了产后大出血的发生,避免了子宫切除,术后产妇恢复良好,并发症发生率低,适于广泛推广。

Objective To explore the clinic effect of uterine artery ligation on prevention of postpartum hemorrhage in cesarean section for placenta praevia.Methods 62 cases of parturient woman undergoing cesarean section were randomly divided into control group and observation group according to the random number table method,with 31cases in each.The patients in the control group were treated with intrauterine packing gauze to stop bleeding,while the patients in the observation group received uterine artery ligation to prevent postpartum hemorrhage.The operation time,indwelling time of filling material,intraoperative blood loss,intraoperative blood transfusion,postoperative 24 h blood loss,body recovery during the half year after operation and complications in one-year follow-up were compared between the two groups.Results The mean operation time and indwelling time of filling material in the observation group were significantly shorter than those in the control group.The intraoperative blood loss,intraoperative blood transfusion and postoperative 24 h blood loss in the observation group were significantly less than those in the control group.The difference was statistically significant （P〈0.05）.There was no difference in lochia elimination rate half year after operation,menstruation recovery rate,normal menstrual cycle and mormal secretion rate of breast milk between the two groups （P〉0.05）.The incision of uterus and abdominal wall of parturient woman in the two groups were healed well after operation.In the observation group,2 cases of parturient woman had postoperative fever,in contrast with 10 cases in the control group （P〈0.05）.There was no significant difference in the incidence of intrauterine adhesions and menstrual changes in two groups in the one-year follow-up （P〉0.05）.Conclusion Uterine artery ligation on prevention of postpartum hemorrhage in cesarean section for placenta praevia is effective and easy to operate,which can effectively control severe bleeding during and after operation,significantly reduce the incidence of postpartum hemorrhage,achieve good postoperative recovery without hysterectomy and decrease incidence of complications.Hence it is worthy of clinical promotion.