不同止血方法治疗产后出血的效果与安全性比较

The comparison of therapeutic efficacy and safety between multiple hemostatic methods in postpartum hemorrhage

目的探讨不同止血方法在产后出血(PPH)应用后的疗效与安全性。方法回顾性选取我院从2016年7月~2019年6月收治的73例剖宫产术后PPH孕产妇,将采取Bakri球囊宫腔填塞方法止血的33例孕产妇作为Bakri球囊组,剩余使用COOK双球囊宫腔填塞方法止血的40例孕产妇作为COOK双球囊组。比较两种球囊填塞的止血方法术前、术后的出血量,并比较围手术期平均输血量、成功止血时间、球囊留置时间、住院时间、子宫切除率、术后血红蛋白的变化及并发症发生率。结果Bakri球囊组与COOK双球囊组相比较,其年龄、孕次、产次、体重指数、孕周、新生儿出生体重等一般情况差异均无统计学意义(P>0.05);两组术前出血量、术前血红蛋白及球囊留置时间相比差异无统计学意义(P>0.05),但在术后出血量、平均输血量、成功止血时间、住院时间、术后血红蛋白含量相比差异有统计学意义(P<0.05);Bakri球囊组与COOK双球囊组术后子宫切除率及各并发症发生率比较均无统计学意义(P>0.05)。结论COOK双球囊宫腔填塞对PPH的止血效果优于Bakri球囊宫腔填塞,术后出血量及平均输血量少,止血时间及住院时间短,且不会增加术后再次出血、感染、子宫切除等术后并发症发生率。

Objective To investigate the therapeutic efficacy and safety of multiple hemostatic methods in postpartum hemorrhage(PPH).Methods Retrospective selection seventy-three cases with PPH after cesarean delivery who were admitted inour hospital from July 2016 to June 2019.33 receiving Bakri balloon intrauterine tamponades were classified into the Bakri balloon group,and 40 accepting COOK’s balloon(a double balloon device)into the COOK’s balloon group.The amount of preoperative and postoperative bleeding was compared between the two groups.The average blood transfusion volume,length of time to hemostasis,balloon distention time,length of hospital stay,hysterectomy rate,postoperative hemoglobin levels and incidence rates of complications during perioperative period were also compared.Results There were no significant differences in clinical characteristics,such as age,number of pregnancies,number of parity,body mass index(BMI),gestational weeks and birth weight of neonate,between the Bakri balloon group and the COOK’s balloon group(P>0.05).No significant differences in the amount of preoperative bleeding,preoperative hemoglobin levels and balloon distention time were found between the two groups(P>0.05).However,there were significant differences in the amount of postoperative bleeding,the average blood transfusion volume,length of time to hemostasis,length of hospital stay and postoperative hemoglobin levels between the two groups(P<0.05).No significant differences in postoperative hysterectomy rate and incidence rates of complications were found between the two groups(P>0.05).Conclusion COOK’s balloon presented superior hemostatic effects on PPH over Bakri balloon,featuring decreased average blood transfusion volumes andlength of time to hemostasis and hospital stay with a low incidence rate of complications such as postoperative bleeding,infection and hysterectomy.