宫腔球囊压迫与B-Lynch缝合止血对前置胎盘剖宫产产后出血的止血效果及应激指标的影响

Effects of intrauterine balloon compression and B-Lynch suture on hemostatic effect stress and indexes of postpartum hemorrhage after cesarean section with placenta previa

目的探讨宫腔球囊压迫与B-Lynch缝合止血对前置胎盘剖宫产产后出血的止血效果及应激指标的影响。方法选取2018年1月至2020年4月期间于莆田盛兴医院行剖宫产分娩的90例产后出血前置胎盘产妇,按照治疗方式不同分为压迫组(45例)和缝合组(45例)。压迫组予宫腔球囊压迫处理,缝合组行B-Lynch缝合止血。比较两组止血效果、产后2 h和24 h出血量、应激指标、并发症。结果压迫组止血有效率高于缝合组,产后2 h和24 h出血量少于缝合组,差异有统计学意义(P<0.05);术后24 h,两组肾上腺素(E)、皮质醇(Cor)、去甲肾上腺素(NE)水平均高于术前,差异有统计学意义(P<0.05),术后24 h,压迫组E、Cor、NE水平低于缝合组,差异有统计学意义(P<0.05);两组总并发症发生率相比,差异无统计学意义(P>0.05)。结论宫腔球囊压迫与B-Lynch缝合止血均是治疗前置胎盘剖宫产产后出血的安全性手段,但前者止血效果更好,能够减少产后出血量,减轻患者创伤应激状态,值得临床推广。

Objective To investigate the hemostatic effect of uterine balloon compression and B-Lynch suture to stop bleeding after cesarean section with placenta previa and their influences on stress indicators.Methods 90 pregnant women with postpartum hemorrhage and placenta previa who underwent cesarean section in Putian Shengxing Hospital from January 2018 to April 2020 were selected.According to different treatment methods,they were divided into compression group(45 cases)and suture group(45 cases).The compression group were treated with uterine balloon compression,and the suture group were treated with B-Lynch suture to stop bleeding.And then,the hemostatic effects as well as blood losses,stress indicators and complications at 2 h and 24 h after delivery were compared between the two groups.Results The effective rate of hemostasis in the compression group was higher than that of the suture group,and the blood losses at 2 h and 24 h after delivery were lower than those of the suture group(P<0.05).At 24 h after operation,the levels of adrenaline(E),cortisol(Cor)and norepinephrine(NE)of the two groups were higher than those before operation,and the difference was statistically significant(P<0.05).At 24 h after operation,the levels of E,Cor and NE in the compression group were lower than those in the suture group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the total complication rate between the two groups(P>0.05).Conclusion Both uterine balloon compression and B-Lynch suture hemostasis are safe methods for the treatment of postpartum hemorrhage after cesarean section with placenta previa,but the former has better hemostasis effect,which can reduce postpartum hemorrhage and relieve the traumatic stress state of patients,and thus is worthy of promotion in clinical practice.