探讨紧急子宫切除术在难治性产后出血中的应用及产后出血的高危因素及其防治措施

Study on Application of Emergency Uterectomy in the Refractory Postpartum Hemorrhage and High-risk Factors of Postpartum Hemorrhage and Its Preventive and Treatment Measures

目的探讨产后出血的高危因素及其防治措施及紧急子宫切除术在难治性产后出血中的应用。方法对该院2007年1月—2016年12月收治的46例难治性产后出血产妇的临床资料进行统计分析。结果研究组产妇中胎盘因素、妊高症、剖宫产、子宫收缩无力、疤痕子宫比例89.5%、26.3%、68.4%、26.3%、15.8%均显著高于对照组70.4%、11.1%、51.9%、11.1%、7.4%(P<0.05);非条件Logistic回归分析显示,难治性产后出血高危因素包括胎盘因素、妊高症、剖宫产、子宫收缩乏力、疤痕子宫(P<0.05);研究组患者的出血量(4 500±1 000)m L显著少于对照组(7 500±1 000)m L(P<0.05),恢复良好率84.2%显著高于对照组66.7%(P<0.05)。结论产后出血的高危因素包括胎盘因素、妊高症、剖宫产、子宫收缩乏力、疤痕子宫,子宫切除的主要指征包括疤痕子宫、胎盘病理,紧急子宫切除术在难治性产后出血中的应用效果好。

Objective To study the application of emergency uterectomy in the refractory postpartum hemorrhage and high-risk factors of postpartum hemorrhage and its preventive and treatment measures.Methods The clinical data of 46 cases of delivery women with refractory postpartum hemorrhage admitted and treated in our hospital from January 2007 to December 2016 were counted.Results The ratios of placental factors,pregnancy induced hypertension,cesarean section,uterine atony and scar uterus in the research group were obviously higher than those in the control group,(89.5%,26.3%,68.4%,26.3%,15.8%vs 70.4%,11.1%,51.9%,11.1%,7.4%)(P<0.05);the unconditional Logistic regression analysis showed that the high-risk factors of intractable postpartum hemorrhage included placental factors,pregnancy induced hypertension,cesarean section,uterine atony and scar uterus(P<0.05);the bleeding amount in the research group was obviously lower than that in the control group[(4 500±1 000)mL vs(7 500±1 000)mL](P<0.05),and the recovery good rate in the research group was obviously higher than that in the control group,(84.2%vs 66.7%)(P<0.05).Conclusion The high-risk factors of postpartum hemorrhage include the placental factors,pregnancy induced hypertension,cesarean section,uterine atony,scar uterus and the main signs of hysterectomy include the scar uterus and placenta pathology,and the application effect of emergency uterectomy?in the?refractory postpartum hemorrhage is good.