盆腔血管结扎与介入治疗产后出血患者的效果比较研究

A comparative study of the effects of pelvic vascular ligation and interventional therapy on postpartum hemorrhage

目的观察应用盆腔血管结扎与介入治疗产后出血患者的治疗效果和安全性。方法选取2014年12月至2018年12月治疗的难治性产后出血患者240例,其中采用盆腔血管结扎治疗的120例纳入结扎组,另外采用介入栓塞治疗的120例纳入介入组。比较2组患者术中情况,止血原因及止血成功情况,产后2 h、24 h出血量,恶露持续时间,月经复潮时间,月经周期,住院时间及手术前后的凝血因子水平,相关治疗情况,手术疗效和并发症发生情况。结果2组患者手术时间差异无统计学意义(P>0.05),但介入组患者术中出血量、术中输血量和术中补液量均明显低于结扎组(P<0.01),红细胞输注量、血浆输注量均少于结扎组(P<0.05),止血时间早于结扎组(P<0.05)。介入组患者恶露持续时间、月经复潮时间、月经周期、住院时间均短于结扎组(P<0.05)。介入组患者总止血成功率100.00%高于结扎组59.17%(P<0.05)。2组产后24 h出血量均多于产后2 h出血量(P<0.05),介入组患者产后2 h、24 h出血量均少于结扎组(P<0.05)。2组患者手术后血管紧张素Ⅱ、凝血因子Ⅷ、Ⅸ水平均高于手术前(P<0.05);手术后,介入组患者血管紧张素Ⅱ、凝血因子Ⅷ、Ⅸ水平均高于结扎组(P<0.05);介入组患者手术止血效果明显优于结扎组(P=0.02);介入组患者相关治疗事件发生率1.67%(2/120)低于结扎组10.00%(12/120)(P<0.05)。介入组总体并发症发生率为16.67%,明显低于结扎组的71.67%(P<0.01)。结论介入栓塞治疗难治性产后出血患者疗效显著、安全可靠、患者痛苦小,值得在临床推广应用。

Objective To investigate the clinical effects and safety of pelvic vascular ligation and interventional therapy in treatment of postpartum hemorrhage.Methods A total of 120 patients with intractable postpartum hemorrhage who were treated in our hospital from December 2014 to December 2018 were enrolled in the study,who were randomly divided into intervention group and ligation group,with 60 cases in each group.The intraoperative condition,causes of hemostasis and success of hemostasis,bleeding volume at 2h,24h after childbirth,duration of lochia,menstrual rehydration time,menstrual cycle,length of hospital stay,coagulation factor levels before and after operation,and surgical effects as well as incidence of complications were observed and compared between the two groups.Results There was no significant difference in operation time between the two groups,however,the intraoperative bleeding volume,the intraoperative blood transfusion volume,fluid supply amount,red blood cell infusion volume and plasma infusion volume in intervention group were significantly less than those in ligation group(P<0.01).The hemostasis time,the duration of lochia,menstrual rehydration,menstrual cycle and hospital stay in intervention group were significantly shorter than those in ligation group(P<0.05).Moreover the total success rate of hemostasis in intervention group was 100.00%(120/120),which was significantly higher than that[59.17%(71/120)]in ligation group(P<0.05).The amount of 24h postpartum hemorrhage in intervention group was significantly less than that in ligation group(P<0.05).After operation the levels of angiotensinⅡ,coagulation factorⅧand IX in both groups were significantly higher than those before operation(P<0.05),moreover,which in intervention group were significantly higher than those in ligation group(P<0.05).The hemostasis effects and incidence of complications in intervention group were superior to those in ligation group(P<0.05).Furthermore the incidence of related treatment events in intervention group was significantly lower than that in ligation group(P<0.05).Conclusion The interventional therapy is effective and safe in treating intractable postpartum hemorrhage,which is worthy of clinical application and promotion.