两种不同处理方式防治产后出血的临床效果比较

Comparative analysis of the clinical effect and safety of two different treatment methods in the prevention and treatment of postpartum hemorrhage

目的对比两种不同处理方式防治产后出血的临床效果与安全性,为产后出血防治策略的选择提供参考依据。方法选取204例产妇为研究对象,按照其止血时机分为高危产后出血组(n=108)及产后出血组(n=96),并按照其处理方式分为Bakir球囊填塞组(n=74)、B-Lynch缝合组(n=130)。记录两组产妇止血效果及子宫复旧情况,比较两组的临床效果与安全性。结果两组产妇住院时间、产后感染率、子宫复旧不良率比较,差异无统计学意义(P>0.05)。Bakir球囊填塞组手术时间低于B-Lynch缝合组,差异有统计学意义(P<0.05);高危产后出血组手术时间、住院时间、出血量、术后24 h血红蛋白变化均低于产后出血组,差异有统计学意义(P<0.05)。204例产妇中,188例(92.16%)止血成功,16例(7.84%)止血失败,其中13例行子宫动脉栓塞、3例行子宫切除术。存在混合因素的产妇,其止血失败率高于无高危因素者、存在子宫因素者、存在胎盘因素者,差异有统计学意义(P<0.05)。结论 Bakir球囊填塞操作耗时更短,适用于应急止血。同时,需重视合并混合因素产妇的早期产后出血防治。

Objective To compare the clinical efficacy and safety of two different treatment methods in the prevention and treatment of postpartum hemorrhage, and provide a reference for the selection of prevention and treatment of postpartum hemorrhage. Methods 204 cases of maternal were selected as objects for study.In accordance with the hemostatic time points for the high risk of postpartum hemorrhage group （n=108） and postpartum hemorrhage group （n=96） , and in accordance with the method of treatment they were divided into Bakir balloon tamponade group （n=74） and B-Lynch suture group （n=130）. The hemostatic effects of the two groups were recorded and uterine involution, clinical efficacy and safety were compared between the two groups. Results Hospitalization time, postpartum infection rate, subinvolution of uterus rate of the two group had no significant differences （P〉O.05） , Bakir balloon tamponade group operation time was significantly less than that of the B-Lynch suture group （P〈0.05）. The operation time, length of stay, blood loss, and 24 h hemoglobin changes after operation of the high risk of postpartum hemorrhage group were significantly lower than those of postpartum hemorrhage group （P〈0.05）. Among the 204 cases, 188 cases （92.16%） had successful hemostasis; 16 cases （7.84%） failed to stop bleeding, of which 13 cases underwent uterine artery embolization and 3 cases underwent hysterectomy. There was a mixed factor of maternal, and the failure rate of hemostasis was higher than that of non risk factors; there were significant differences in the uterine and placental factors （P〈0.05）. Conclusion Bakir balloon tamponade operation is less time-consuming and is suitable for the emergency hemostasis. At the same time, we need to pay attention to the early postpartum hemorrhage prevention and treatment of postpartum hemorrhage.