疤痕子宫剖宫产术中出血的因素与预防分析

Factors and Prevention of Bleeding during Cesarean Section of Scar Uterus

目的研究疤痕子宫剖宫产术中出血的因素于预防对策。方法该次研究对象为68例,选取时间为2016年6月—2017年12月期间,将该院所收治的34例行疤痕子宫剖宫产术的产妇作为该次研究组对象,并选择同期来该院行剖宫产的34例产妇为对照组,观察两组产妇手术中的出血情况与止血情况。结果研究组手术中出血率为55.88%,与对照组(11.76%)比较差异有统计学意义(χ~2=14.782 6,P<0.05),研究组出血量为(521±204)mL,对照组出血量为(315±189)mL,两组比较差异有统计学意义(t=4.319 2,P<0.05);研究组子宫破裂5例,约占比例为14.70%,宫缩乏力6例(17.65%),胎盘因素8例(23.53%),切口撕裂0例,与对照组[宫缩乏力1例,约占比例为2.94%,胎盘因素2例(5.88%),切口撕裂1例(2.94%)]比较,两组在子宫破裂、宫缩乏力与胎盘因素方面差异有统计学意义(χ~2=5.396 8、3.981 3、4.220 7,P<0.05);研究组19例在出血后均采取有效的止血措施,其中5例采取止血带于B-lychn缝合止血,4例采取纱布宫腔填塞止血,6例采取子宫局部缝扎止血,其余4例应用子宫动脉上行支缝扎止血措施,所有产妇均成功止血;对照组产妇2例应用纱布宫腔填塞止血,2例采取子宫局部缝扎止血,成功止血。结论对造成疤痕子宫剖宫产术中出血的原因主要是子宫破裂、宫缩乏力等,上述情况临床应该及时采取有效措施,如:子宫动脉上采取支缝扎止血、纱布宫腔填塞止血与止血带联合B-lychn缝合止血等措施。

Objective To study the preventive measures of bleeding in cesarean section of scar uterus.Methods 68 patients were enrolled in this study from June 2016 to December 2017,34 women who underwent cesarean section of the scar uterus admitted to our hospital were selected as subjects of this study group.In the same period,34 women who underwent cesarean section in our hospital were in the control group.The bleeding and hemostasis in the maternal surgery were observed.Results The bleeding rate in the study group was 55.88%,which was significantly different from that in the control group(11.76%)(χ^2=14.782 6,P<0.05).The bleeding volume of the study group was(521±204)mL,and the amount of bleeding in the control group was(315±189)mL,the difference between the two groups was significant(t=4.319 2,P<0.05);the study group had 5 cases of uterine rupture,accounting for 14.70%,6 cases of uterine atony(17.65%),and 8 cases of placental factors(23.53%),0 cases of incision tear,compared with the control group(1 case of uterine weakness,2.94%,2 cases of placental factor(5.88%),1 case of incision tear(2.94%),the two groups had statistically significant differences in uterine rupture,uterine weakness and placental factors(χ^2=5.396 8,3.981 3,4.220 7,P<0.05).In the study group,19 patients took effective hemostasis after hemorrhage,5 of which were taken tourniquet sutured by B-lychn suture,4 cases were treated with gauze uterine filling and hemostasis,6 cases were treated with local uterine suture and hemostasis.The other 4 cases were treated with uterine artery ascending joint and hemostasis.All the women were successfully hemostasis.For example,gauze was filled with uterine cavity to stop bleeding,and 2 cases were treated with local suture to stop bleeding.Conclusion The main cause of bleeding during cesarean section of scar uterus is uterine rupture,uterine contraction,etc.In the above situation,effective measures should be taken in time,such as uterine artery to take joints to stop bleeding,gauze uterine cavity filling and hemostasis tourniquet combined with B-lychn suture to stop bleeding and other measures.