产后出血的原因及预防护理体会

目的：提高对产后出血的护理质量,降低产后并发症及母婴死亡率。方法总结本院5年间产后出血资料,分析出血原因和高危因素。结果产后出血主要原因是子宫宫缩乏力,产后出血高危因素是前置胎盘、人工流产。结论产后出血主要原因为子宫收缩乏力,也不可忽视胎盘因素及其他原因。提高产科护理质量,重视产前保健,正确处理产程,加强产后观察及进行必要产后保健指导,能有效降低产后出血的发生率。     

产后出血致胃肠功能障碍的危险因素分析

目的 探讨产后出血致胃肠功能障碍的相关因素.方法 收集87例产后出血患者的临床资料,分析产后出血致胃肠功能障碍的相关因素.结果 87例产后出血患者中发生胃肠功能障碍30例(34.5％),产后出血的影响因素为年龄、麻醉方式、出血量、合并感染(均P＜0.05).结论 产后出血可导致患者发生胃肠功能障碍.避免高龄妊娠,选择腰麻-硬膜外麻醉,做好产前、产时及产后的护理,建立预防产后出血预案及急救预案,预防和积极控制感染可以降低产后出血发生率,减少产后出血导致的胃肠功能障碍.     

B-Lynch缝合术治疗剖宫产产后出血的临床体会

目的探讨B-Lynch缝合术治疗剖宫产产后出血的方法、疗效。方法回顾性分析13例行B-Lyneh缝合术治疗剖宫产产后出血病例资料。结果 12例采用B-Lynch缝合术治疗剖宫产产后出血成功止血,是一种有效措施。结论 B-Lynch缝合术是剖宫产术中发生产后出血可采用的快速、简单、有效的方法,值得临床推广。     

选择性子宫动脉栓塞治疗产后出血

目的观察选择性子宫动脉栓塞治疗产后出血的疗效。方法回顾性分析21例接受选择性子宫动脉栓塞的产后出血患者,均伴有失血性休克,应用明胶海绵碎屑进行栓塞。结果栓塞术后,所有患者出血停止,血压上升,心率减慢,血红蛋白上升,与术前比较差异有统计学意义（P〈0.05）。术后随访1年,无复发出血及严重并发症发生。结论选择性子宫动脉栓塞是治疗产后出血微创、有效的方法。     

B-lynch缝合术治疗产后出血16例分析

目的评价B-lynch缝合术对剖宫产产后出血的止血效果。方法回顾性分析16例剖宫产后出血病例,出血量500~1 800 m l,均应用B-lynch缝合止血。结果全部成功止血,子宫得以保留,治愈率100%。术后无副作用,子宫复旧良好。结论B-lynch缝合术是治疗剖宫产产后出血的一个行之有效的方法,操作简便,有临床推广价值。     

介入综合治疗腹膜后纤维化1例

患者男,73岁,主因“腰痛,双下肢水肿3个月,加重3天”入院。查体：脊柱四肢无畸形．双下肢指凹性水肿Ⅱ度。双下肢血管彩超示双下肢深静脉血栓形成。腹部MR平扫于腹膜后腹主动脉周围见长T1短T2信号包绕,范围从肾动脉水平延伸到双侧髂总动脉。增强CT示病灶轻度强化（图1）。静脉肾盂造影（intravenous urography,IVU）示双侧肾盂、     

益母草注射液配合宫腔水囊压迫止血法在前置胎盘剖宫产术后出血的应用

目的探讨益母草注射液配合宫腔水囊压迫止血法治疗前置胎盘剖宫产产后出血的临床效果。方法将40例前置胎盘剖宫产产后出血患者随机分为实验组和对照组。在剖宫产术中,对照组采用宫腔水囊压迫止血,实验组在宫腔水囊压迫的基础上,术中予子宫下段肌层注射益母草注射液80mg,以后每12小时肌肉注射益母草注射液1次,每次40mg,连续注射3d。观察两组患者术中、产后2h、产后24h时出血量,并观察治疗期间的不良反应。结果两组治疗方法均达到了止血目的,实验组患者术后2h出血量、术后24h出血量均明显少于对照组（P〈0.05）。两组治疗期间无明显不良反应。结论益母草注射液配合宫腔水囊压迫止血法能更有效地减少前置胎盘剖宫产术后出血,安全性较好。     

Can measuring blood loss at delivery reduce hemorrhage-related morbidity?

Quantitation of blood loss after vaginal and cesarean delivery has been advocated for the timely detection of postpartum hemorrhage and activation of protocols for resuscitation. Morbidity and mortality from postpartum hemorrhage is considered to be largely preventable and is attributed to delayed recognition with under-resuscitation or inappropriate resuscitation. Optimizing detection of postpartum hemorrhage through refining how blood loss is measured is therefore clinically relevant. In this review on quantitative blood loss for postpartum hemorrhage, recent advances in the methods used to quantitate blood loss will be reviewed, with a comparison of utility and precision for blood loss measurement after vaginal and cesarean delivery. Considerations for the implementation of a quantitative blood loss system on the labor and delivery unit, including its benefits and challenges, will be discussed. The existing evidence for impact of blood loss quantitation in obstetrics on hemorrhage-related morbidity will be delineated, along with knowledge gaps and future research priorities.     

Postpartum hemorrhage--an update

Postpartum hemorrhage remains a major cause of maternal morbidity and mortality. The incidence of postpartum hemorrhage appears to be increasing in developed countries due to an increased number of placenta accreta or percreta after previous Cesarean deliveries. The initial therapy of postpartum hemorrhage consists of uterotonic drugs and inspection of the uterine cavum. At the same time, optimization of the clotting potential should be initiated early. Tranexamic acid may be considered as a first line choice, followed by fibrinogen if necessary. If bleeding continues, fresh frozen plasma and packed red cells should be ordered in a ratio of 1:1, as this ratio has been shown to improve survival in trauma victims. All labor and delivery suites should have standard operating procedures for the management of postpartum hemorrhage in place with regular drills.     

Two cases of hemorrhage secondary to amniotic fluid embolus managed with uterine artery embolization

PURPOSE: To describe the anesthetic management of two cases of amniotic fluid embolus (AFE) and disseminated intravascular coagulation (DIC) who underwent bilateral uterine artery embolization to control their postpartum hemorrhage. CLINICAL FEATURES: We report the clinical course and management of two women who suffered sudden cardiorespiratory events during labour. The first patient had a cardiac arrest whereas the second developed respiratory failure and altered neurological status. They were diagnosed as having had an AFE. Both of these events were accompanied by severe postpartum hemorrhage and DIC. They suffered prolonged bleeding and received massive transfusions. Successful management of hemorrhage was optimized by uterine artery embolization, thus avoiding ongoing problems with bleeding and possible hysterectomy. The role of uterine artery embolization is described, along with its advantages and anesthetic considerations. CONCLUSION: Women with severe postpartum hemorrhage, with or without DIC, should be considered for uterine artery embolization.     

子宫收缩乏力性出血的临床分析

目的探讨子宫收缩乏力性产后出血的原因及处理方法。方法回顾性分析2006年1月～2009年1月治疗子宫收缩乏力性产后出血27例患者,给予加强子宫收缩药物等方法治疗。结果 27例患者经治疗全部痊愈,无一例孕产妇死亡。结论子宫收缩乏力性出血的发病原因为精神因素导致的交感神经舒缩功能变化、产前合并症的存在及产程延长。对产后出血中子宫收缩乏力的病因,进行积极预防、治疗可避免子宫切除,利于保留患者生育功能。     

B-Lynch缝合术在宫缩乏力性产后出血的应用(附69例临床分析)

目的探讨B-Lynch缝合术在剖宫产宫缩乏力性产后出血的临床效果。方法176例剖宫产宫缩乏力性产后出血的病例,在处理剖宫产术中出血时,研究组69例应用B-Lynch缝合术,对照组107例采用8字缝合血窦与宫腔填纱。结果研究组手术时间、术中平均出血量、术后24 h出血量分别为(34.6±6.4)min、(407.6±29.4)ml与(443.8±21.2)ml,均明显少于对照组的(49.3±10.2)min、(520.7±42.3)ml及(562.4±31.7)ml(P<0.05)。所有产妇无腹痛、恶露排出不畅等不良反应,术后42 d超声检查示子宫复旧好,切口愈合佳,恶露均已净。结论应用B-Lynch缝合术可以有效控制剖宫产产后宫缩乏力引起的出血。     

不同妊娠期阴道出血对母婴健康影响的研究

目的 探讨不同妊娠期阴道出血对母婴健康的影响程度,以利于提供针对性的护理干预和健康指导。方法 对418例妊娠期有阴道出血的孕妇进行跟踪观察至产后。结果 妊娠晚期阴道出血孕妇中重度贫血发生率为27.66％,难产和产后出血发生率分别为65.96％、19.15％,早产和低出生体重发生率为38.30％、25.53％,与妊娠早、中期比较,差异有显著性意义(均P<0.01)。结论 需加强对妊娠各期阴道出血产妇的护理,积极开展健康教育,使之得到及时的治疗和护理,保证母婴健康。     

剖宫产术中宫颈捆扎加正方形缝合预防中央性前置胎盘产后出血

目的探讨剖宫产术中宫颈捆扎加正方形缝合预防中央性前置胎盘产后出血的效果。方法 研究组中央性前置胎盘34例,在暂时阻断子宫血流下行子宫下段和(/或)宫颈内口局部正方形缝合以预防中央性前置胎盘剖宫产后大出血,必要时加行子宫动脉下行支结扎。26例中央性前置胎盘患者为对照组,采用常规方法预防产后出血。结果研究组在平均出血量、平均手术时间、宫腔填纱率、子宫切除率以及产褥病率方面均明显优于对照组(P0.05或P0.01)。术后56~60 d B超检查两组子宫复旧情况,研究组32例(94.1%)子宫复旧良好,对照组20例(90.0%)恢复正常,组间比较无统计学差异(P0.05)。结论该方法具有安全、止血快、效果可靠、能保留子宫等优点,是预防中央性前置胎盘剖宫产出血的可靠方法。     

剖宫产术中挤压法子宫肌瘤剔除与无肌瘤剖宫产的比较研究

目的：通过与无肌瘤剖宫产对比,评价剖宫产术中挤压法子宫肌瘤剔除的安全性。方法2008年1月～2010年12月,剖宫产术中挤压法剔除子宫肌瘤128例（肌瘤组）,选择肌瘤组病例的后一例无子宫肌瘤剖宫产为对照组128例。比较2组产后出血量、产后出血率、产后发热及术后住院时间。结果2组产后出血量[（233．6±58．9） ml vs．（228．5±90．9）ml, t＝0．530, P＝0．597],出血率[0％（0/128） vs．0．8％（1/128）, P＝1．000],血红蛋白下降[（6．17±2．83） g/L vs．（6.89±3．09）g/L, t＝-1．944, P＝0．053],红细胞压积下降（2．22％±0．98％ vs．2．27％±1．02％, t＝-0．400, P＝0．690）,发热率[2．3％（3/128） vs．5．5％（7/128）,χ2＝1．665, P＝0．197]及术后住院时间[（4．2±0．8）d vs．（4．1±1．2） d, t＝0．706, P＝0.481]差异均无显著性。结论剖宫产术中挤压法剔除子宫肌瘤,不增加产后出血,也不增加产后感染,是一种简单、微创、安全、可行的手术方法,值得临床推广。     

改良B-Lynch外科缝线术治疗剖宫产术中宫缩乏力性子宫出血的临床观察

目的 探讨改良B-Lynch外科缝线术在治疗剖宫产术中产后出血的应用价值.方法 选择涧西区人民医院和汝阳县人民医院妇产科2004年9月～2008年7月剖宫产术中宫缩乏力性出血患者32例,随机分为观察组和对照组.观察组20例行改良B-Lynch外科缝线术;对照组12例行宫腔纱布条填塞术.结果 两种方法对治疗产后出血均有效,但观察组手术时间（52.56±10.56）min短于对照组（69.54±19.92）min;差异有极显著性（P＜0.01）;产后出血量比较,观察组少于对照组,差异有极显著性（P＜0.01）;产褥病率：观察组1例（1/20）,对照组3例（3/12）,两组比较差异有极显著性（P＜0.01）.结论 改良B-Lynch外科缝线术治疗剖宫产术中宫缩乏力性产后出血具有操作简单,手术时间短,止血效果好,疗效确切,并发症少等优点.     

59例难治性宫缩乏力产后出血首次手术干预分析

目的探讨首次选择5种干预性手术在抢救难治性宫缩乏力性产后出血的应用价值。方法回顾性分析2006年3月至2013年2月间,首次采用宫腔填塞(塞纱)、B-Lynch缝合、CHO缝合、子宫动脉栓塞术、子宫切除5种干预性手术的59例难治性宫缩乏力性产后出血病人的临床资料。结果首次止血成功50例,成功率84.75%,其中17例宫腔填塞(塞纱)成功14例,22例B-Lynch缝合成功17例,9例CHO缝合成功8例,9例经导管动脉栓塞术(TAE)及2例子宫切除术均抢救成功,各组间止血成功率比较,差异均无统计学意义(P>0.05)。结论 5种止血手术对于难治性宫缩乏力性产后出血均有良好的止血效果,具体处理方案需根据当时具体情况制定。     

An inquiry into late postpartum hemorrhage

An effort has been made to review the general subject of late postpartum hemorrhage and to scrutinize the great variety of pathologic entities which may be involved in this serious obstetrical complication concerning which little has been written in a comprehensive way. The importance of considering general systemic disorders and neuropsychiatric factors as well as the gamut of purely gynecic lesions and aberrations has been emphasized. Although therapeutic suggestions appear throughout the article, it is beyond the scope of this paper to take up the management of the numerous pathologic conditions which may be involved in instances of delayed hemorrhage postpartum or postabortum. Emphasis has been placed throughout on a consideration of the natural history of the various morbid conditions, with a view to prophylaxis wherever possible; early diagnosis and, accordingly, prompt and adequate intervention. No phase of obstetric practice is more important than an appreciation of the factors involved in the care of women with late postpartum hemorrhage.     

早孕期骨密度正常妇女产褥期骨密度分析

目的分析早孕期骨密度正常妇女产褥期骨密度情况,分析产前、产时、产后各种因素对产褥期骨密度的影响。方法对210名在海淀妇幼保健院建档并住院分娩的早孕期桡骨骨密度正常的妇女在产褥期进行超声骨密度测定,分析孕前体重指数、孕期体重增长、分娩方式、胎儿体重、产后出血、产后喂养方式、产后补钙情况、产后户外活动等对产褥期骨密度的影响。结果早孕期骨密度正常的妇女在产褥期骨密度正常者占90.5%,骨量减少占9.5%,骨质疏松0%。210名妇女产褥期骨密度较早孕期减少,差异有统计学意义(P0.05)。产后出血量多于500m L,孕期体重增加超过12.5kg,产后未补钙及产后户外活动少的产妇,产褥期骨密度较低,差异有统计学意义(P0.05)。而孕前体重指数、分娩方式、胎儿体重、产后喂养方式对产褥期骨密度无影响(P0.05)。结论产褥期骨密度较早孕期下降,孕期控制体重增长、产褥期补钙、适当户外活动,可减少骨量流失。