| 摘要: |
| 目的 探讨宫腔球囊填塞、纱条填塞及B-Lynch缝合3种止血措施在预防和治疗产后出血中的作用。方法 选择2013年1月至2014年10月在我院产科住院分娩,具有产后出血高危因素或发生产后出血的266例产妇,分别采用宫腔Bakri球囊填塞(114例)、纱条填塞(69例)或B-Lynch缝合术(83例)以预防或治疗产后出血。分析3种止血方法的止血效果以及不同止血时机、高危因素与止血效果间的关系。结果 宫腔Bakri球囊填塞、纱条填塞及B-Lynch缝合3种止血方法的止血成功率分别为90.4%、94.2%和92.8%,组间差异无统计学意义(P>0.05),且在住院时间、产后感染及子宫复旧方面3种止血方法间的差异也无统计学意义(P>0.05),但宫腔Bakri球囊填塞组的手术时间[(46.08±13.8) min]短于纱条填塞组[(56.49±12.94) min]及B-Lynch缝合组[(52.36+21.11) min],差异有统计学意义(P<0.01)。按止血时机分,134例预防性止血组的成功率为100%,132例治疗性止血组的成功率为84.1%,两组间差异有统计学意义(P<0.01),且预防组产后感染率低于治疗组(P<0.01)。当胎盘因素和子宫因素同时存在时出血量及止血失败率均高于单因素时(P<0.01)。结论 虽然3种止血方法在止血效果、住院时间、产后感染及子宫复旧方面无差异,但Bakri球囊填塞用时最短,可作为一种应急止血方法为进一步治疗争取时间。止血成功率与采取何种外科止血方法无关,而与止血措施采取的时机相关,处理越早止血效果越好。当胎盘因素和子宫因素同时存在时,止血失败率高,应做好抢救预案,尽早采取止血措施来减少产后出血量。 |
| 关键词: Bakri球囊 B-Lynch缝合术 宫腔填塞 产后出血 |
| DOI：10.16781/j.0258-879x.2016.04.0435 |
| 投稿时间：2015-08-26修订日期：2016-03-04 |
| 基金项目: |
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| Efficacies of intrauterine balloon tamponade, intrauterine gauze tamponade and B-Lynch suture in prevention and treatment of postpartum hemorrhage |
| SHI Yi-ru,LIN Jing,ZHANG Li-jun* |
(International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai Jiaotong University, Shanghai 200030, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the efficacies of intrauterine balloon tamponade, intrauterine gauze tamponade and B-Lynch suture in prevention and treatment of postpartum hemorrhage. Methods A total of 266 patients with high risk of postpartum hemorrhage or postpartum hemorrhage in our hospital from January 2013 to October 2014 were included in this study. They received intrauterine Bakri balloon tamponade (n=114), intrauterine gauze tamponade (n=69) or B-Lynch suture (n=83). The hemostatic effects of three methods and their relationship with different hemostasis occasions and high risk factors were analyzed. Results The hemostatic rates of intrauterine balloon tamponade, gauze tamponade and B-Lynch suture were 90.4%, 94.2% and 92.8%, respectively, with no significant differences found between the 3 groups (P>0.05). The hospitalization time, postpartum infection or involution of the uterus of three methods were not significantly different (P>0.05). The operation period was (46.08±13.8) min for intrauterine Bakri balloon tamponade, (56.49±12.94) min for intrauterine gauze tamponade, and (52.36±21.11) min for B-Lynch suture,with that of Bakri balloon group being significantly shorter than the other two groups (P<0.01). As for hemostatic occasion, 134 cases received preventive hemostatic treatment and were all successful, while 132 cases receiving hemostatic treatment had a successful rate of 84.1%, being significantly lower than that of the prevention hemostasis group (P<0.01); moreover, the postpartum infection rate was significantly lower in the prevention group compared with hemostatic treatment group (P<0.01). When placenta factor and uterine factor exist at the same time, the bleeding rate and bleeding volume of the mixed factor were significantly higher than that of single factor (P<0.01). Conclusion The three hemostasis methods have no differences in their hemostatic effects, hospitalization time, postpartum infection and uterine involution, with Bakri balloon's operation having the shortest time, therefore it may serve as an emergency hemostasis method to win more time for further treatment. The success rate of hemostasis depends not on the hemostasis method, but on the right occasions, the earlier the better. When placenta factor and uterine factor exist at the same time, the failure rate of hemostasis is higher, and emergency plans should be taken to reduce postpartum hemorrhage as soon as possible. |
| Key words: Bakri balloon B-Lynch suture uterine packing postpartum hemorrhage |
