产后出血临床病例分析

Clinical analysis of postpartum hemorrhage

目的评估不同出血量产妇的临床干预措施及结局。方法回顾性分析2016年1月至2018年12月于广州医科大学附属第三医院发生产后出血的283例产妇的临床资料,按出血量分为三组:A1组(1000~<2000mL,n=171)、A2组(2000~<3000mL,n=58)、A3组(≥3000mL,n=54),比较不同组产妇一般情况、妊娠结局、干预措施等。结果分娩方式、瘢痕子宫、前置胎盘、胎盘植入、ICU转入例数在不同组的差别有统计学意义(均P<0.05),所有产后出血患者入院及出院前血红蛋白(HGB)、红细胞比容(HCT)、纤维蛋白原差异无统计学意义(均P>0.05);三组患者使用卡前列甲酯、氨甲环酸/氨甲苯酸、钙剂、晶体液、羟乙基淀粉、输血、外科手术干预措施总次数、盆腔血管结扎、子宫部分/子宫全切例数差别均有统计学意义,且除卡前列甲酯外,与A1组相比,A2和A3组需要干预的比例或总量更大(F/χ^(2)值分别为7.137、6.407、14.024、34.548、67.635、102.900、45.540、49.320、91.121,均P<0.05);三组患者使用卡前列素氨丁三醇及其他外科干预手段差别无统计学意义(均P>0.05);在182例接受输注血液制品治疗的患者中,三组接受红细胞及新鲜冰冻血浆的总量差别有统计学意义,且随着出血量的增加,需要接受输血治疗的总量更大(F值分别为102.900、77.503,均P<0.05);三组接受其他血制品包括输注血小板、纤维蛋白原、凝血酶原复合物的总量差别无统计学意义(P>0.05)。结论对于胎盘植入、前置胎盘等高危出血患者,应合理容量治疗,针对性采取药物及外科干预,可以提高患者预后。

Objective To evaluate clinical intervention and outcome of the parturients with different amount of bleeding during delivery.Methods The clinical data of 283 parturients who suffered from postpartum hemorrhage and were treated in The Third Affiliated Hospital of Guangzhou Medical University from Janurary 2016 to December 2018 were analyzed retrospectively.According to the amount of bleeding,the parturients were divided into three groups as follows:group A1(1000~<2000 mL,n=171),group A2(2000~<3000 mL,n=58)and group A3(≥3000 mL,n=54).The general conditions,pregnancy outcomes,surgical interventions of the parturients were compared among the three groups.Results In mode of delivery,scarred uterus,placenta previa,placenta implantation and number of referral to ICU,there were significant differences among the three groups(all P<0.05).While there were no statistically significant differences in hemoglobin(HGB),hematocrit(HCT)or fibrinogen at admissionand and before discharge of all parturients with postpartum hemorrhage(all P>0.05).There were statistically significant differences in total administration frequencies of carboprost methylate,tranexamic acid/aminomethylbenzoic acid,calcium agent,crystal solutions,hydroxyethyl starch,blood transfusion,surgical interventional procedures,and total numbers of pelvic artery ligation,subtotal hysterectomy/total hysterectomy among the three groups,and except carprost methylate,the total intervention numbers and administration dosages in group A2 and group A3 were more than those in group A1(F/χ^(2)=7.137,6.407,14.024,34.548,67.635,102.900,45.540,49.320 and 91.121 respectively,all P<0.05).There were no statistically significant difference in use of carpromazine and other surgical interventions among the three groups(all P>0.05).Among 182 patients who were treated with blood products,there were statistically significant differences in the total transfusion amounts of red blood cells and fresh frozen plasma among the three groups,and with increase in blood loss,the total amount of blood transfusion required was larger(F=102.900 and 77.503 respectively,both P<0.05).While there were no significant differences in the total transfusion amount of platelet,fibrinogen and thrombin complex required(all P>0.05).Conclusion For those patients with high-risk bleeding such as placenta implantation and placenta previa,reasonable plasm volume expanding therapy is very important,taking some reasonable medications and surgical interventions can improve the prognosis of the patients.