产科急症子宫切除术在抢救产科大出血中的应用

Application of emergency obstetric hysterectomy in the treatment of obstetric hemorrhage

目的探讨产科急症子宫切除术在抢救产科大出血中的应用。方法本次研究回顾性的分析了10例急症行子宫切除术患者的临床资料。结果 10例孕产妇首先采用保守治疗无效的情况下行子宫切除术,弥散性血管内凝血(DIC)6例孕产妇(其中;1例孕产妇为羊水栓塞,2例孕产妇为双胎妊娠合并妊娠高血压性心脏病,3例孕产妇为胎盘早剥),1例孕产妇为剖宫产手术后晚期子宫切口感染,1例孕产妇为胎盘粘连,1例孕产妇为子宫收缩乏力,1例孕产妇为子宫破裂。手术时间65~140 min,平均时间(95±6)min。术中出血总量在1 550~3 680 m L之间,平均(2 350±210)m L。10例孕产妇均进行急症子宫切除手术后治愈出院,住院时间8~15 d,平均住院时间(11.5±2.5)d。急症子宫切除术的术中出血量和手术时间明显少于常规手术,差异具有统计学意义(P<0.05)。引发产妇行子宫切除的原因较多,主要有年龄因素、分娩方式、子宫收缩乏力、凝血功能障碍、胎盘因素等。结论产后大出血产妇采用产科急症子宫切除术是最有效的治疗方法。

Objective To investigate the application of emergency obstetric hysterectomy in the treatment of obstetric hemorrhage.MethodsThis study retrospectively analyzed the clinical data of10patients undergoing emergency hysterectomy.Results10cases of pregnant women;firstlyperformed uterine conservative treatment invalid resection,disseminated intravascular coagulation(DIC)in6cases(including1cases;maternalamniotic fluid embolism,2cases of pregnant women for twin pregnancy pregnancy with hypertensive heart disease,3cases of maternal placental abruption),1cases of pregnant women for advanced uterine incision infection after cesarean section,1cases of maternal placental adhesion,1cases ofmaternal uterine atony,1cases of maternal uterine rupture.The operation time was65-140min,and the average time was(95±6)min.The total intraoperativebleeding was between1550-3680mL,with an average of(2350±210)mL.10cases of pregnant women were cured by emergency hysterectomy.The hospital stay was8-15d days,and the average hospitalization time was(11.5±2.5)d.During the emergency hysterectomy,theamount of bleeding and the time of operation were significantly less than those of conventional surgery,the difference was statistically significant,the difference was statistically significant(P<0.05).There are many reasons for vaginal hysterectomy,including age,mode of delivery,uterine atony,coagulation dysfunction,placenta factor,etc.Conclusion Obstetric emergency hysterectomy is the most effective treatment for postpartum hemorrhage.