不同时机B-Lynch缝合术治疗剖宫产宫缩乏力性产后出血的临床效果及预后分析

Clinical Effect and Prognosis Analysis of Different Timing B-Lynch Suture for Postpartum Hemorrhage Caused by Cesarean Section Uterine Inertia

目的观察剖宫产宫缩乏力性产后出血在不同时机实施B-Lynch缝合术的效果及预后。方法临床资料采集佳木斯市妇幼保健院2017年7月—2018年7月产科治疗的90例宫缩乏力所致剖宫产产后出血患者,按不同止血时机分为两组,每组各45例。对照组出血量增加至1000ml时行B-Lynch缝合术,观察组出量增加至500ml时,保守止血无缓解后行B-Lynch缝合术;比较两组止血效果及预后。结果观察组术中出血量为(1175.23±80.36)ml,术后2h出血量为(40.32±8.15)ml,24h出血量为(920.41±80.63)ml,输血量为(211.32±17.05)ml,均较对照组少,差异有统计学意义(P<0.05);两组卵巢激素水平相比差异无统计学意义(P>0.05);观察组恶露时间为(28.71±2.81)d,相较于对照组的(32.54±3.81)d短,差异有统计学意义(P<0.05);观察组术后不良反应率为6.67%,相较于对照组的28.89%更低,差异有统计学意义(P<0.05)。结论剖宫产宫缩乏力性产后出血早期实施B-Lynch缝合术能有效止血,减少术后出血量,且降低不良反应风险。

Objective To observe the effect and prognosis of B-Lynch suture in different timing of postpartum hemorrhage caused by cesarean section uterine inertia. Methods Clinical data of 90 patients with postpartum hemorrhage caused by cesarean section uterine inertia were collected from July,2017 to July,2018. Patients were divided into two groups according to different hemostasis timing,with 45 cases in each group. The B-Lynch suture was performed at 1 000 ml. When the volume of the observation group increased to 500ml,the B-Lynch suture was performed after conservative hemostasis without remission,and the hemostatic effect and prognosis of the two groups were compared. Results In the observation group, the intraoperative blood loss(1 175.23±80.36)ml, postoperative 2h(40.32±8.15)ml and 24h blood loss(920.41±80.63)ml,and blood transfusion(211.32±17.05)ml were less than the control group. There was statistically significant difference(P <0.05). There was no statistical difference in ovarian hormone levels be? tween the two groups(P >0.05). The lochia time of the observation time group(28.71±2.81)d was shorter than the control group (32.54±3.81)d,and there was statistically significant difference(P <0.05). The adverse reactions of the group were 6.67%,which was lower than that of the control group(28.89%). There was statistically significant difference(P <0.05).Conclusion The early implementation of B-Lynch suture in cesarean section with uterine contraction and postpartum hemorrhage can effectively stop bleeding, reduce postoperative bleeding,and reduce the risk of adverse reactions.