| 凶险性前置胎盘致产后大出血患者的急症子宫切除术手术时机探讨 |
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| 引用本文： | 蒋玲玲,刘颖蕾,刘曼华,陈丽平,乔海风.凶险性前置胎盘致产后大出血患者的急症子宫切除术手术时机探讨[J].中华全科医学,2017,15(11):1915-1917. |
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| 作者姓名： | 蒋玲玲 刘颖蕾 刘曼华 陈丽平 乔海风 |
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| 作者单位： | 南通市第一人民医院妇产科, 江苏 南通 226001 |
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| 基金项目： | 2016年度江苏省南通市卫计委青年医学人才科研基金项目 (WQ2016029) |
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| 摘 要： | 目的 探讨凶险性前置胎盘致产后大出血患者的急症子宫切除术的手术时机。 方法 选择2013年1月—2016年1月期间于南通市第一人民医院妇产科收治的凶险性前置胎盘并产后大出血患者70例，按照患者治疗方法不同分为观察组22例和对照组48例。对照组患者在剖宫产术中促宫缩治疗无法止血后，给予子宫切除术，观察组患者行子宫动脉栓塞术，期间观察患者出血量，若出血量仍较多，超过1 000 ml，上述措施无效，再给予子宫切除术。观察并比较2组患者的一般资料，子宫切除前出血量、术中总出血量、输血量、手术时间、住院时间、抗生素应用时间等手术情况及并发症发生情况。 结果 2组患者一般资料比较差异无统计学意义(P＞0.05)。观察组患者子宫切除前出血量、术中总出血量均显著多于对照组(P<0.05)。观察组患者新鲜冰冻血浆输注量显著高于对照组(P<0.05)。观察组手术时间长于对照组，差异有统计学意义(P<0.05)。但2组患者在住院时间、抗生素应用时间上比较，差异无统计学意义(P＞0.05)。2组患者术后并发症发生率比较差异无统计学意义(P＞0.05)。 结论 在保证血液供应及时及家属知情同意的基础上，凶险性前置胎盘致产后大出血患者可先行保守治疗再行子宫切除术，以尽量减少切除子宫对患者造成的伤害，同时，可为患者保留生育功能，但治疗过程中应密切监控患者出血情况，若经保守治疗仍无法止血应尽早进行子宫切除术。
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| 关 键 词： | 凶险性前置胎盘 产后大出血 子宫切除术 手术时机 |
| 收稿时间： | 2017-02-27 |
A preliminary study on the timing of an emergency hysterectomy in patients with postpartum hemorrhage caused by dangerous placenta praevia |
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| Affiliation: | Department of Obstetrics and Gynecology, the First People' Hospital of Nantong City, Nantong, Jiangsu 226001, China |
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| Abstract: | Objective To investigate the timing of an emergency hysterectomy in patients with postpartum hemorrhage caused by dangerous placenta praevia. Methods Seventy patients with placenta praevia and postpartum hemorrhage in our hospital from January,2013 to January,2016 were divided into observation group(22 cases) and control group(48 cases) according to the treatment.The patients in the control group received uterine resection on account of the bleeding did not stop after promoting uterine contractions in the cesarean section.The hysterectomy was carried out in patients in the observation group after uterine artery embolization was invalid and the bleeding volume exceeded more than 1 000 ml.The general information of the patients,the amount of bleeding before hysterectomy,the total amount of blood loss,the amount of blood transfusion,the time of operation,the time of hospitalization,the time of antibiotic application and the occurrence of complications were observed and compared between the two groups. Results There was no significant difference in the general information of the patients between the two groups(P>0.05).The total amount of bleeding before and during the hysterectomy in the observation group was significantly higher than those in the control group(P<0.05).The fresh frozen plasma infusion in the observation group was significantly higher than that in the control group(P<0.05).The operation time of the observation group was longer than that of the control group,the difference was statistically significant(P<0.05).However,there was no significant difference between the two groups in hospitalization time and antibiotic application time(P>0.05).There was no significant difference in postoperative complication rate and mortality between the two groups(P>0.05). Conclusion The conservative treatment can be conducted before the hysterectomy in the patients with postpartum hemorrhage caused by dangerous placenta praevia when the blood supply can be ensured and family of informed consent,so as to reduce as much as possible the harm caused to patients by hysterectomy,and retain the fertility function of patients.During the treatment process,the bleeding should be closely monitored,and the hysterectomy should be performed as soon as possible if the conservative treatment is still unable to stop bleeding. |
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