卡前列素氨丁三醇注射液和宫腔纱条填塞及改良低位B-Lynch缝合术治疗前置胎盘致难治性产后出血的临床疗效

Clinical efficacy of carboprost tromethamine,intrauterine gauze packing and improved low B-Lynch suture in treating intractable postpartum hemorrhage caused by placenta previa

目的探讨卡前列素氨丁三醇注射液、宫腔纱条填塞及改良低位B-Lynch缝合术治疗前置胎盘致难治性产后出血(PPH)的临床疗效。方法选取重庆市计生医院2012年8月—2015年1月收治的前置胎盘致难治性PPH产妇56例,随机分为对照组(n=26)和观察组(n=30)。对照组产妇采用缩宫素及行"8"字间断缝合术治疗,观察组产妇采用卡前列素氨丁三醇注射液、宫腔纱条填塞及改良低位B-Lynch缝合术治疗。随访4~12个月,比较两组产妇术中出血量、术后24 h出血量、止血时间、血性恶露持续时间、月经恢复正常时间及预后。结果两组产妇术中出血量比较,差异无统计学意义(P>0.05);观察组产妇术后24 h出血量少于对照组,止血时间、血性恶露持续时间、月经恢复正常时间短于对照组(P<0.05)。两组产妇止血失败率比较,差异无统计学意义(P>0.05)。两组产妇均未出现晚期产后出血及产褥感染。结论采用卡前列素氨丁三醇注射液、宫腔纱条填塞及改良低位B-Lynch缝合术治疗前置胎盘致难治性PPH的临床效果确切,可协同发挥强效止血的作用,有利于产后子宫复旧。

Objective To evaluate the clinical efficacy of carboprost tromethamine, intrauterine gauze packing and improved low B -Lynch suture in treating intractable postpartum hemorrhage （PPH） caused by placenta previa. Methods A total of 56 cases of maternal with intractable PPH caused by placenta previa were selected from August 2012 to January 2015 in Family Planning Hospital of Chongqing City, which were randomly divided into control group （ n = 26） and observation group （n = 30）. Control group was given oxyteein and the ＂ 8＂ interrupted suture, observation group was treated with earboprost tromethamine, intrauterine gauze packing and improved low B - Lynch suture. Followed - up 4 - 12 months, the peroperative bleeding, postoperative 24 h intraoperative bleeding, the bleeding time, duration time of bloody loehia, menses recovery time and the prognosis were compared between the two groups. Results There was no significant difference in peroperative bleeding between the two groups （ P 〉 0. 05 ） ; the observation group of postoperative 24 h intraoperative bleeding was less than control group, the bleeding time, duration time of bloody loehia and menses recovery time were shorter than control group （ P 〈 0. 05 ）. No statistically significant difference of failed rate to stop bleeding was found between the two groups （ P 〉 0. 05 ）. Both groups had no late postpartum hemorrhage and puerperal infection happened. Conclusion Carboprost tromethamine, intrauterine gauze packing and improved low B - Lynch suture have an obviously clinical effect in treating intractable PPH caused by placenta previa, it plays a role of powerful hemostasis, and is benefit for the involution of the uterus after parturition.