爱佑球囊联合改良B-Lynch缝合术治疗难治性产后出血的临床观察

Clinical observation of Aiyou balloon combined with modified B-Lynch suture in the treatment of intractable postpartum hemorrhage

目的研究爱佑球囊联合改良B-Lynch缝合术治疗难治性产后出血(intractable postpartum hemorrhage,IPH)的效果分析。方法选取2017年2月至2022年2月无锡市妇幼保健院IPH患者62例,按照随机数字表法分为对照组和观察组,各31例。对照组采用改良B-Lynch缝合术,观察组采用爱佑球囊联合改良B-Lynch缝合术。比较两组手术情况(手术时间、术中出血量、术后24 h出血量、输血量),对比两组止血效果及产前、产后24 h的凝血功能包括凝血酶原时间(prothrombin,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维原蛋白(fibrinogen,FIB),并统计术后1个月并发症。结果两组手术时间比较,差异无统计学意义(P>0.05)。观察组术中出血量(851.26±81.25)mL、术后24 h出血量(142.37±24.89)mL、输血量(1.57±0.39)U,低于对照组(1089.47±100.39)mL、(312.58±36.25)mL、(2.48±0.43)U(P<0.05)。观察组止血效果等级分布优于对照组(P<0.05)。产后24 h两组PT、APTT、TT均延长,FIB减小(P<0.05)。产后24 h观察组PT(13.55±1.42)s、APTT(37.58±4.18)s、TT(16.89±1.57)s,短于对照组(14.78±1.63)s、(40.74±4.32)s、(18.95±1.81)s,FIB(1.89±0.32)g/L大于对照组(1.71±0.28)g/L(P<0.05)。观察组并发症发生率3.23%,低于对照组22.58%(P<0.05)。结论爱佑球囊联合改良B-Lynch缝合术治疗IPH能降低出血量与输血量,提高止血效果,改善凝血功能,降低并发症发生率。

Objective To study the effect of Aiyou balloon combined with modified B-Lynch suture in the treatment of intractable postpartum hemorrhage(IPH).Methods Sixty-two patients with IPH in Wuxi maternal and Child Health Hospital from Feb.2017 to Feb.2022 were randomly divided into control group and observation group,with 31 cases in each group.The control group was treated with modified B-Lynch suture,and the observation group was treated with Aiyou balloon combined with modified B-Lynch suture.The operation conditions(operation time,intraoperative bleeding,24 h postoperative bleeding and blood transfusion)of the two groups were compared,the hemostatic effect and coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB)]of the two groups were compared,and the complications one month after operation were counted.Results There was no significant difference in operation time between the two groups(P>0.05).The amount of intraoperative bleeding(851.26±81.25)mL,24 h postoperative bleeding(142.37±24.89)mL and blood transfusion(1.57±0.39)U in the observation group were lower than those in the control group(1089.47±100.39)mL,(312.58±36.25)mL,(2.48±0.43)U(P<0.05).The grade distribution of hemostatic effect in the observation group was better than that in the control group(P<0.05).At 24 hours postpartum,Pt,APTT and TT were prolonged and FIB decreased in both groups(P<0.05).Pt(13.55±1.42)s,APTT(37.58±4.18)s and TT(16.89±1.57)s in the observation group were shorter than those in the control group(14.78±1.63)s,(40.74±4.32)s,(18.95±1.81)s at 24 hours postpartum,and FIB(1.89±0.32)g/L was greater than those in the control group(1.71±0.28)g/L(P<0.05).The incidence of complications in the observation group was 3.23%lower than 22.58%in the control group(P<0.05).Conclusion Aiyou balloon combined with modified B-Lynch suture in the treatment of IPH can reduce the amount of bleeding and blood transfusion,improve the hemostatic effect,improve the coagulation function and reduce the incidence of complications.