产后出血21例临床分析

目的探讨产后出血的发生率、防范、处理方法及结局。方法回顾性分析同济大学附属第十人民医院2008年产科住院分娩中发生产后出血的21例患者临床资料。结果产后出血发生率1.139%（21/1 843）。其中剖宫产的产后出血发生率1.835%（18/981）,明显高于阴道分娩的产后出血发生率0.348%（3/862）。其中15例应用促宫缩药物、止血药、输血、手术中出血部位的缝扎止血等措施出血减少;3例在上述处理无效采用子宫捆绑式压迫后出血减少;3例在上述处理均无效而行子宫全切术。所有病例抢救成功。结论产前对产后出血高危因素的充分评估及积极准备,及时发现产后出血并尽快找到原因,及时对因处理及输血,必要时的子宫捆绑式压迫可减少产后出血量,子宫全切术是抢救产妇生命的有效方法。

Clinical analysis of 21 cases of postpartum hemorrhage

Objective To explore the incidence, prevention, treatment and outcome of postpartum hemorrhage. Methods Clinical data of 21 patients labored with postpartum hemorrhage in Tenth People＇ s Hospital,Tongji University during last year （2008） were analyzed. Results The incidence of postpartum hemorrhage was about 1. 139% （21/1 843）, in which the incidence of excessive blood loss following vaginal delivery was about 0. 348 % （3/862）, significantly lower than that of Cesarean section （ 18/981 ）. Among the 21 excessive hemorrhage cases, 15 cases were salvaged through medicinal treatment, blood transfusion, and timely suture at obvious bleeding sites, 3 cases were rescued by using B-lynch suture, and other 3 cases were given emergent hysterectomy after all the above procedures failed. All cases survived. Conclusion To cure postpartum hemorrhage, obstetrical professionals need to comprehensively evaluate and positively prepare for the high risks of postpartum hemorrhage before labor. In the treatment, the key point is to eliminate hemorrhagic causes and giving blood transfusion. A suitable uterine compress suture is often effective while emergent hysterectomy is the most important surgical procedure to rescue lives.