产后出血280例临床病例分析

Clinical analysis of 280 cases of postpartum hemorrhage

目的 探讨不同产后出血量产妇的干预措施、并发症及输血情况。方法 回顾性分析2018年6月至2021年5月于山西医科大学第一医院分娩的280例产后出血产妇的临床资料,按其出血量分为3组:1 000~<2 000 ml组213例,2 000~<3 000 ml组32例,≥3 000 ml组35例,比较3组间的干预措施、并发症及输血情况。结果 3组产妇在孕周、孕次、产次、瘢痕子宫、前置胎盘、胎盘植入、凶险性胎盘植入、剖宫产率及转入ICU发生率比较,差异有统计学意义(P<0.01,P<0.05)。干预措施中,子宫压迫缝合术(31.5%、62.5%、60.0%)、子宫动脉结扎术(0.5%、9.4%、20.0%)、盆腔血管栓塞术(2.8%、9.4%、11.4%)、子宫全切术(0、0、25.7%)和子宫次全切术(0、0、5.7%)发生率3组比较,差异有统计学意义(P<0.01,P<0.05)。3组产妇弥散性血管内凝血(0、6.3%、20.0%)、失血性休克(0.5%、3.1%、34.3%)、肺损伤(0、6.3%、2.9%)的发生率,差异有统计学意义(P<0.05)。在246例接受输注血液制品治疗的患者中,3组间随着出血量的增加,输注红细胞及新鲜冰冻血浆的量随之增大(H=126.228、35.598,P<0.01)。结论 对产后出血量进行分级预警,有助于针对性地采取药物及外科干预措施,合理输注血液成分,提高产妇预后。

Objective To explore the intervention measures, complications and blood transfusion in the puerpera with different amount of postpartum hemorrhage(PPH). Methods A retrospective analysis was performed on the clinical data of 280 women with postpartum hemorrhage who gave birth at the First Hospital of Shanxi Medical University from June 2018 to May 2021.According to the amount of bleeding, the patients were divided into 1 000-2 000 ml group(n=213), 2 000-<3 000 ml group(n=32) and ≥3 000 ml group(n=35). The intervention measures, complications during and postpartum and blood transfusion the intervention measures, complications and blood transfusion were observed and compared among the three groups. Results There were statistical differences in gestational weeks, times of pregnancy and delivery, scarred uterus, placenta previa, placenta accreta, dangerous placenta accreta, cesarean section rate and the incidence of transfer to ICU among three groups(P<0.01, P<0.05). There were statistical differences in the intervention measures of uterine compression suture(31.5%,62.5%,60.0%), uterine artery ligation(0.5%,9.4%,20.0%), pelvic vascular embolization(2.8%,9.4%,11.4%), total hysterectomy and subtotal hysterectomy(P<0.01, P<0.05). There were significant differences in the incidences of disseminated intravascular coagulation(DIC)(0,6.3%,20.0%), hemorrhagic shock(0.5%,3.1%,34.3%) and lung injury(0,6.3%,2.9%) among three groups(P<0.05). With the increase of bleeding volume, the infusion of red blood cells and fresh frozen plasma increased in 246 patients who received infusion therapy of blood product among three groups(H=126.228, 35.598, P<0.01). Conclusion The early warning grading of postpartum hemorrhage is helpful to take targeted drug, surgical intervention measures and reasonable blood component infusion so as to improve the maternal outcomes of PPH.