3种方案治疗宫缩乏力性难治性产后出血临床观察

Clinical observation of three schemes in the treatment of intractable postpartum hemorrhage due to uterine asthenia

目的探讨3种方案治疗宫缩乏力性难治性产后出血(IPH)的临床价值。方法回顾性分析150例宫缩乏力性IPH患者的临床资料,根据治疗方案的不同把患者分为A、B、C组。A组行宫腔纱条填塞,B组行改良B-Lynch缝合,而C组行改良B-Lynch缝合联合宫腔纱条填塞。对比3组的治疗情况、子宫收缩能力指标、性激素水平指标、子宫血流动力学指标。结果止血时间、住院时间、血性恶露持续时间、术后1d出血量均以C组最少,B组次之,A组最多(P<0.05)。与A组相比,B、C组的舒张末期流速(EDV)、收缩期血流值速度(PSV)、术后6周雌二醇(E2)均明显升高,一氧化氮(NO)、一氧化氮合酶(NOS)、阻力指数(RI)、术后6周促黄体生成素(LH)、术后6周促卵泡生成素(FSH)均明显降低(P<0.05)。与B组相比,C组的EDV、PSV、术后6周E2均明显升高,NO、NOS、RI、术后6周LH、术后6周FSH明显降低(P<0.05)。结论改良B-Lynch缝合联合宫腔纱条填塞治疗宫缩乏力性IPH效果最好,可以减少止血时间、住院时间、血性恶露持续时间和术后1d出血量,改善子宫收缩能力、性激素水平和子宫血流动力学。改良B-Lynch缝合术效果次之,宫腔纱条填塞效果最差。

Objective To investigate the three schemes in the treatment of intractable postpartum hemorrhage(IPH)due to uterine asthenia.Methods The clinical data of 150 patients with uterine asthenia IPH were retrospectively analyzed.According to the different treatment schemes,the patients were divided into groups A,B and C.Group A underwent intrauterine gauze packing and group B underwent modified B-Lynch suture,while group C underwent Modified B-Lynch suture combined with uterine gauze packing.The treatment,uterine contractility,sex hormone level and uterine hemodynamics of the three groups were compared.Results The Hemostasis time,length of hospital stay,duration of bloody lochia,amount of bleeding one day after operation in the group C were the least,those in group B were more than group C,while those in group A were the most in the three groups(P<0.05).Compared with group A,the end diastolic flow velocity(EDV),systolic flow velocity(PSV),estradiol(E_2)at six weeks after operation were significantly higher in group B and C.In comparison with group A,the nitric oxide(NO),nitric oxide synthase(NOS),resistance index(RI),luteinizing hormone(LH)at six weeks after operation and follicle stimulating hormone(FSH)at six weeks after operation were significantly lower in group B and C(P<0.05).Compared with group B,EDV,PSV and E_2 at six weeks after operation were significantly higher in group C,and NO,NOS,RI,LH at six weeks after operation and FSH at six weeks after operation were significantly lower in group C(P<0.05).Conclusions Uterine gauze packing combined with Modified B-Lynch suture has the best effect in the treatment of uterine asthenia IPH,which can reduce the hemostasis time,hospital stay,duration of bloody lochia and the amount of bleeding one day after operation,and improve the uterine contractility,sex hormone level and uterine hemodynamics.The effects of modified B-Lynch suture are the second,and the effects of intrauterine gauze packing are the worst.