剖宫产术中大出血145例临床分析

A Clinical Analysis of 145 Cases of Hemorrhage in Cesarean Section

目的 :探讨剖宫产术中大出血的原因及防治措施。方法 :收集本院 1989年 1月至 1998年 12月剖宫产术中出血 >10 0 0ml的病例 14 5例 ,所有病例分为A、B两组 ,对子宫收缩乏力引起的出血 ,A组采用增加缩宫素用量及按摩子宫或加用乙醚 ,B组除增加缩宫素用量及按摩子宫外 ,再加用卡孕栓舌下含化或塞肛门。对胎盘剥离面广泛渗血者 ,A组采用纱布块直接压迫 ,B组为明胶海绵加凝血酶覆盖创面后再加纱布块压迫。结果 :剖宫产术中大出血的主要原因为子宫收缩乏力 ,占 36 .5 5 %。其次为胎盘粘连 ,占 2 4 .14 %。B组的子宫切除率与贫血发生率明显低于A组。结论 :剖宫产术中大出血与许多因素有关 ,最主要的原因是子宫收缩乏力及胎盘粘连 ,术中加强宫缩、及时缝合、凝血酶加压迫止血的应用及全身综合治疗可以明显改善病人预后 ,减少子宫切除及术后贫血的发生。

Objective:To study the causes and interference of hemorrhage in cesarean section. Methods: 45 cases of hemorrhage in cesarean section from Jan, 1989 to Dec,1998 whose bleeding amount ≥1000 ml were reviewed. All cases were devided into two groups: group A and group B. In group A, patients were treated with an increased dosage of syntocinon plus massaging uterus or using ether. In group B, patients were treated with carports kept in mouth under hypoglottis or inserting into anus in addition to all the methods mentioned above. For extensive diffuse bleeding on the trauma surface of uterus, only pledges were directly pressed on the surface in group A. Meanwhile the pledges were covered with additional Gelfoam and Thrombase in group B. Results: The major cause resulted in hemorrhage in cesarean section was uterine inertia, which accounted for 36.55%. The other cause was placental adherence, which account for 24.14%.The rates of hysterectomy and anemia in group B were significantly lower than in group A. Conclusion:Many factors are associated with hemorrhage in cesarean section. The major causes were uterine inertia and placental adherence. Application of strengthening the uterine, sewing up in time, stanching with thrombase, and curing the bodies synthesize could improved the patient's prognosis evidently and reduced the rates of hysterectomy and anemia after operation.