B-Lynch缝合术在剖宫产宫缩乏力性产后出血中应用时机的探讨

The Timing of B-lynch Suture for Atonic Postpartum Hemorrhage During Cesarean Section

目的探讨不同时机B-Lynch缝合术治疗剖宫产宫缩乏力性产后出血的效果。方法北京市海淀区妇幼保健院2012年1月~2014年12月剖宫产术中因宫缩乏力而发生产后出血90例,出血量达到500 ml即行B-Lynch缝合66例(早缝组),出血量达到1000 ml才行B-Lynch缝合24例(迟缝组),比较2组缝合止血效果、出血量、输血率、DIC发生率、术后住院时间、产褥病率的差异。结果 2组90例均经B-Lynch缝合止血成功,经综合治疗康复出院。早缝组产后出血量(656±118)ml,显著少于迟缝组的(1550±432)ml(t=-10.003,P=0.001);早缝组输血率3.0%(2/66),显著低于迟缝组的50.0%(12/24)(χ~2=26.092,P=0.000);早缝组未发生DIC(0/66),迟缝组为16.7%(4/24)(Fisher检验,P=0.004);早缝组产褥病率[3.0%(2/66)]也少于迟缝组[25.0%(6/24)](χ~2=7.952,P=0.005)。2组术后住院时间差异无显著性(P>0.05)。结论 B-Lynch缝合术是治疗剖宫产宫缩乏力性产后出血的有效方法,且早运用能取得更好的疗效,出血少,DIC及产褥病率等并发症的发生率低。推荐出血量达到500 ml,且一般保守止血方法效果不佳时立即采取B-Lynch缝合。

Objective To investigate the appropriate timing of B-lynch suture in the treatment of atonic postpartum hemorrhage during cesarean section.Methods A total of 90 patients with atonic postpartum hemorrhage during cesarean section from January 2012 to December 2014 in our hospital were included in the study.They were divided into two groups, early suture group （applying B-lynch suture when the amount of postpartum hemorrhage reaching 500 ml, n=66 cases） and late suture group （applying B-lynch suture when the amount of postpartum hemorrhage reaching 1000 ml, n=24 cases）.The hemostatic effect, amount of bleeding, blood transfusion rate, incidence of DIC, duration of hospitalization, and the puerperal morbidity were compared between the two groups.Results All the 90 patients were successfully treated and were discharged after comprehensive treatment.The amount of postpartum hemorrhage of the early suture group was （656±118） ml, which was significantly less than that of the late suture group [（1550±432） ml, t=-10.003, P=0.001].The rate of blood transfusion of the early suture group was 3.0% （2/66）, which was significantly lower than that of the late suture group [（50.0%, 12/24）, x^2=26.092, P=0.000].There was no case of DIC in the early suture group, and the incidence of DIC in the late suture group was 16.7% （4/24）, with the difference statistically significant （Fisher＆#39;＆#39;s exact test, P=0.004）.The puerperal morbidity in the early suture group was 3.0% （2/66） and that of the late suture group was 25.0% （6/24）, with statistically significant difference （x^2=7.952, P=0.005）.There was no statistically significant difference in the hospitalization stay between the two groups （P〉0.05）.Conclusions B-Lynch suture is an effective method in the treatment of atonic postpartum hemorrhage during cesarean section, and early use of it can get better curative effect, such as less bleeding amount and lower rates of blood transfusion, DIC and complications like puerperal morbidity.In case the bleeding volume reaches 500 ml and the general conservative hemostatic methods are ineffective, B-Lynch suture is recommended immediately.