Bakri子宫填塞球囊导管在难治性产后出血中的应用及失败原因分析

Application of Bakri uterine tamponade balloon catheter in treatment of intractable postpartum hemorrhage

目的探讨Bakri子宫填塞球囊导管在治疗难治性产后出血中的应用,并对其止血失败的原因进行分析。方法回顾性分析2013年1月-2015年9月该院收治的因难治性产后出血使用Bakri球囊治疗的患者,分析其治疗效果,并对其止血失败的原因进行分析。结果该研究应用Bakri子宫填塞球囊导管患者共91例,产后出血原因主要为前置胎盘、子宫收缩乏力和胎盘植入。止血成功82例,成功率为90.1%;止血失败9例,失败率9.9%。9例失败患者中胎盘植入残留胎盘出血、休克及弥散性血管内凝血(DIC)未纠正、球囊脱出或注液不足是失败的因素。结论 Bakri子宫填塞球囊导管应用相对简便,容易掌握,可以实时观察出血量,有效治疗产后出血。前置胎盘伴胎盘植入,产后出血伴休克、DIC;球囊放置不当或注液不足是引起放置球囊失败的主要原因,预防性应用Bakri球囊导管有待进一步研究。

Objective To evaluate the therapeutic efficacy of Bakri uterine tamponade balloon catheter in the treatment of intractable postpartum hemorrhage. Methods The clinical data of 91 patients with intractable postpartum hemorrhage undergoing Bakri uterine tamponade balloon catheter were retrospectively analyzed. The therapeutic effcacy was evaluated, and the causes of failure in hemostasis were analyzed. Results In the 91 patients the causes of intractable postpartum hemorrhage included uterine inertia, placenta increta and placenta prevail. Hemostasis was successful in 82 cases （90.1%）, failed in 9 cases （9.9%）. Among the 9 failure patients, placenta prevail complicated with placenta increta, uncorrected DIC, prolapse or insuffcient water injection of balloon were the risk factors. Conclusions Application of Bakri uterine tamponade balloon catheter is a simple procedure, during which the amount of bleeding can be observed in real time. It can effectively treat intractable postpartum hemorrhage and reduce the amount of hemorrhage. Placenta prevail complicated with placenta increta, hemorrhagic shock, DIC, and incorrect placement or insuffcient water injection of balloon are the causes of failure in hemostasis using Bakri balloon catheter. Prophylactic use of Bakri balloon catheter is to be further researched.