Bakri子宫填塞球囊导管治疗难治性产后出血效果及失败原因分析

Analysis of the therapeutic effect and causes of failure of Bakri uterine tamponade with balloon catheterization for hemostasis of women with refractory postpartum hemorrhage

目的:探讨Bakri子宫填塞球囊导管治疗难治性产后大出血的疗效及失败原因。方法:回顾性收集2016年8月—2018年8月本院收治的难治性产后大出血患者临床资料102例,患者均行Bakri子宫填塞球囊导管治疗,并将止血成功患者纳入成功组,止血失败患者纳入失败组,对比两组临床资料和手术情况。结果:102例治疗成功92例(90.2%),治疗失败10例(9.8%);球囊放置前,成功组的总出血量少于失败组,输血、合并弥散性血管内凝血、合并休克发生比例低于失败组;球囊放置后,成功组置后2h出血量和总出血量均少于失败组(均P<0.05)。治疗失败10例中,5例为胎盘植入(其中有2例合并胎盘植入),1例因球囊脱出导致失败, 2例因注液不足导致失败,2例因合并弥散性血管内凝血、休克未及时纠正导致失败。结论:对于难治性产后大出血患者,给予Bakri子宫填塞球囊导管治疗止血效果好,成功率高,治疗前有胎盘植入、球囊脱出、注液不足、弥散性血管内凝血、休克未及时纠正等可能是导致Bakri子宫填塞球囊导管治疗失败的原因。

Objective:To explore the clinical efficacy and causes of failure of Bakri uterine tamponade with balloon catheterization.Methods:The clinical data of 102 women with refractory postpartum hemorrhage from August 2016 to August 2018 were retrospective analyzed,and all women had undergone Bakri uterine tamponade with balloon catheterization.The women with successful hemostasis were included in group A,and women with failed hemostasis were included in group B.The general data and surgical conditions of women were compared between the two groups,and the causes of hemostasis failure were analyzed further.Results:In the 102 women,92(90.2%)cases were successfully hemostasis and 10(9.80%)were failed.Before the balloon placement,the average bleeding volume of women in the group A was significant less than that of women in the group B(P<0.05).The rates of transfusion,disseminated intravascular coagulation,and shock of women in the group A were significant lower than those of women in the group B(P<0.05).After balloon placement,the amount of bleeding in 2 hours and total bleeding amount of women in group A were significant less than those of women in group B(P<0.05).In the group B,there were 5 women with placenta implantation,I woman with balloon detachment,2 women with insufficient injection,and 2 women with the disseminated intravascular coagulation and shock.Conclusion:Bakri uterine tamponade with balloon catheter used in women with refractory postpartum hemorrhage has high effectiveness and high success rate.Placenta implantation,balloon detachment,insufficient fluid injection,disseminated intravascular coagulation and shock failure to correcting maybe the causes of failure for Bakri uterine tamponade.