宫腔止血囊放置时机对阴道分娩后宫缩乏力性产后出血输血治疗的影响

Predictors of transfusion therapy in women managed with the timing of placing intrauterine balloon tamponade for atony after vaginal delivery

目的:探讨宫腔止血囊止血时机对阴道分娩后宫缩乏力性产后出血孕妇输血治疗的影响。方法:回顾分析2016年1月1日至2019年12月31日在南京大学医学院附属鼓楼医院妇产科阴道分娩后发生宫缩乏力性产后出血并使用宫腔止血囊治疗的238例孕妇的临床资料,根据产后是否输注成分血分为输血治疗组(80例)和未输血治疗组(158例)。结果:输血治疗组和非输血治疗组孕妇的年龄、分娩孕周、孕次、产次和产后出血高危因素均无显著差异(P>0.05)。台上放置止血囊者,填塞前失血量显著低于下台后放置者(P=0.003),两者止血成功率分别为95%和100%(P=0.611),输血率分别为34.7%和27.8%(P=0.421)。输血治疗组在填塞前失血量、产时失血量、24h失血量、填塞前休克指数均显著高于未输血治疗组(P=0.000),但产后Hb水平和产后Hb<70g/L占比无显著差异(P>0.05);输血治疗组宫腔止血囊注水量高于未输血治疗组(P<0.05),但止血囊持续压迫时间无显著差异(P=0.109)。产前贫血、人工剥离胎盘均增加产后输血风险(P<0.05),填塞水囊前失血量>800ml(OR=2.9,95%CI为1.4~6.1)和休克指数≥1(OR=5.2,95%CI为2.6~10.4)的患者产后输血风险显著增加(P<0.01)。结论:阴道分娩发生宫缩乏力性产后出血需要止血囊填塞时,无论产时还是产后观察期间,放置前出血量不超过800ml或休克指数<1时,可以减少产后输血。

Objective:To explore the effect on maternal blood transfusion of the timing of placing intrauterine balloon tamponade for the management of postpartum hemorrhage which caused by uterine inertia after vaginal delivery.Methods:We retrospectively collected 238 patients who managed with intrauterine balloon tamponade for atony after vaginal delivery between January 1st,2016 and December 31st,2019 in Department of Obstetrics and Gynecology of Nanjing Drum Tower Hospital.The patients were divided into transfusion group(80 cases)and non-transfusion group(158 cases)depending on transfusion therapy.Results:There was no statistical difference in age,gestational age,gravidity,parity,and risk factors for postpartum hemorrhage between two groups(all P>0.05).The median blood loss before placing the balloon was significantly lower than the placement after delivery group,both of two groups had a high successful rate(95%vs 100%,P=0.611),blood transfusion rates were similar between two groups(34.7%vs 27.8%,P=0.421),packing red blood cells did not increase significantly(P=0.336).The median within transfusion group blood loss and shock index before placing the balloon,postpartum blood loss,total blood loss in 24 hours after delivery were all significantly higher than those in non-transfusion group(P=0.000),but levels of hemoglobin after delivery and the proportion of Hb<70g/L had no difference(P>0.05).The volume of balloon was significantly more in the transfusion group,but the time of continuous compression of balloon tamponade was similar between the two groups(P=0.109).Factors found to affect blood transfusion in the logistic multivariate analysis were prenatal anemia and artificial placenta(P<0.05),while blood loss was greater than 800ml(OR=2.9,95%CI:1.4~6.1)or shock index≥1(OR=5.2,95%CI:2.6~10.4)before placing the balloon,the risk of transfusion was significantly increased(P<0.01).Conclusion:Postpartum hemorrhage due to uterine atony after first-line treatment failed to stop bleeding,the balloon was inserted when blood loss less than 800ml or shock index<1 can significantly reduce blood transfusion.