两种不同止血方式对凶险性前置胎盘患者剖宫产术中出血及预后的影响

目的 对比两种不同止血方式对凶险性前置胎盘患者行剖宫产术中出血及预后的影响.方法 选取2015年1月至2016年12月在陕西省宝鸡市妇幼保健院行剖宫产术的凶险性前置胎盘患者146例,随机分为对照组与观察组各73例.对照组术中胎盘、胎儿娩出后用B-Lynch进行缝合,并在其子宫下段用纱布进行填塞与止血,而观察组术中胎盘、胎儿娩出后,在患者子宫动脉下行支结扎术联合子宫下段行压迫缩窄缝合术,并对比两组手术时间、术中与术后出血量及预后情况.结果 观察组手术时间、术中总出血量及术后1天总出血量均显著低于对照组(t值分别为-3.14、-5.36、-6.25,均P<0.05);观察组术后住院时间、术后应用卡前列素氨丁三醇剂量均显著低于对照组(t值分别为-4.76、-8.64,均P<0.05).结论 相比子宫下段纱布进行填塞与止血,子宫动脉下行支结扎术联合子宫下段行压迫缩窄缝合术可明显减少凶险性前置胎盘患者行剖宫产术中出血量,改善患者预后,可作为一种简单、方便、可行的止血手段,值得临床应用.

Comparison of the effects of two different hemostatic methods on intraoperative hemorrhage and prognosis in patients with pernicious placenta previa during cesarean section

Objective To compare the effects of two different hemostatic methods on intraoperative hemorrhage and prognosis in patients with pernicious placenta previa during cesarean section .Methods A total of 146 cases of pernicious placenta previa undergoing cesarean section were selected in Maternal and Child Health Care of Baoji City , and they were randomly divided into control group and observation group with 73 cases in each group .The control group were treated with B-Lynch sutures and uterine lower segment packing after delivery of placenta and baby during the operation , while the observation group underwent ligation of descending branch of uterine artery combined with compression sutures at the lower uterine segment .The operative duration , intraoperative and postoperative hemorrhage and prognosis were compared between two groups .Results The total operative duration , intraoperative bleeding volume and total bleeding volume one day after surgery were lower in the observation group than those in the control group (t value was -3.14, -5.36 and -6.25, respectively, all P<0.05).The hospitalization time and dosage of carboprosttromethamine after surgery in the observation group were lower than those in the control group (t value was -4.76 and -8.64, respectively, both P<0.05).Conclusion Compared with the uterine lower segment packing and hemostasis , the method of ligation of descending branch of uterine artery combined with compression sutures at the lower uterine segment can significantly reduce the volume of intraoperative hemorrhage in patients with pernicious placenta previa during cesarean section, and can improve the prognosis of patients , which can be used as a simple , convenient and feasible way to reduce bleeding loss .So it is worthy of applying in clinics .