子宫体双侧动脉缝扎术用于剖宫产围术期宫缩乏力性出血临床研究

Clinical study of uterine bilateral arterial suture for perioperative uterine inertial hemorrhagein cesarean section

目的:探讨子宫体双侧动脉缝扎术用于剖宫产围术期宫缩乏力性出血的临床效果。方法:选择2015年1月至2016年1月延安市人民医院收治的剖宫产围术期出现宫缩乏力导致的产后出血患者80例,按照数字随机法分为两组,各40例,所有患者均行宫颈钳夹法结合药物欣母沛治疗,观察组在以上治疗无效后,实施子宫体双侧子宫动脉缝扎术,比较两组治疗后2小时及24小时失血量,凝血功能变化,并统计两组发生的并发症情况及术后1年时患者性生活质量。结果:观察组治疗后2小时及24小时失血量显著少于对照组,差异具有统计学意义(P <0. 05),干预后观察组凝血功能检查指标中PT、TT、APTT及Fib等均显著优于对照组,差异具有统计学意义(P <0. 05),观察组发生术后感染、严重疼痛及失血性休克的总比例显著低于对照组,差异具有统计学意义(P <0. 05),术后1年时随访发现,观察组干预后FSFI评分各指标及总分均显著高于对照组,差异具有统计学意义(P <0. 05)。结论:子宫体双侧子宫动脉缝扎术用于剖宫产围术期子宫收缩乏力大出血,能有效的提高止血效果,减少对凝血功能影响,且并发症少,对患者术后性功能影响小。

Objective：To investigate the clinical effect of uterine bilateral arterial suture for perioperative uterine inertial hemorrhage in cesarean section. Methods： 80 patients with postpartum hemorrhage caused by perioperative uterine inertial hemorrhagein Yan＇an People＇s Hospitalfrom January 2015 to January 2016 were selected and divided into two groups according to the number randomized method. All the patients received cervical clamp method combined with drug hemabate for treatment. The observation group receiveduterine bilateral arterial suturewhen the above treatment was invalid. The amount of blood loss within 2 hours and 24 hours after treatment,changes in coaguiation, incidence of compiications and quality of sexual iife at postoperative 1 year were compared between the two groups. Results：The amount ofblood loss in the observation group was significantly lower than that in the control group at 2 hours and 24 hours after treatment, with statistically significant difference （ P 〈 0. 05 ）. The levels of PT, TT, APTT and Fib in the observation group were significantly better than those in the control group, with statistically significant difference （ P 〈 0. 05 ）. The total incidence of postoperative infection, severe pain and hemorrhagic shock in the observation group was significantly lower than that in the control group, with statistically significant difference （ P 〈 0. 05）. After 1 year follow-up, the FSFI score and the total score were significantly higher than those in the control group, with statistically significant difference （ P 〈 0. 05 ）. Conclusions ： Uterine bilateral arterial suture can effectively improve the hemostatic effect and reduce the impact on coagulation when treating the perioperative uterine inertial hemorrhage in cesarean section, with fewer complications and little impact on postoperative sexual function.