产科急症子宫切除13例临床分析

目的探讨产科急症子宫切除的临床情况。方法对我院2004-01～2008-125年间13例产科急症子宫切除病例进行回顾性分析。结果13例产科子宫切除术指征为前置胎盘并胎盘植入、子宫收缩乏力致产后出血、DIC、羊水栓塞、子宫动脉瘤破裂;出血量为1000～17000ml,平均出血量约为5800ml。术后严重并发症包括DIC、急性肾衰、多器官功能障碍综合征（MODS）,无孕产妇死亡;围产儿13例中死亡1例。结论子宫切除是治疗产科急性出血的有效措施之一,加强高危孕产妇的筛查管理,预防产科严重并发症发生,降低剖宫产率可减少产科子宫切除的发生。

Clinical analysis on 13 cases of acute hysterectomy

Objective To investigate the clinical behaviors of puerperas undergoing acute hysterectomy. Methods A restrospective analysis was performed on 13 puerperas undergoing acute obstetrical hysterectomy （AH） from 2004 to 2008 in our hospital. Results The indications for AH among the 13 cases were placenta praevia with placenta accreta, postpartum hemorrhage due to uterine inertia, disseminated intravascular coagulation（DIC）, amniotic fluid embolism , rhexis of uterine aneurysm , respectively. The volume of bleeding ranged from 1000 - 17000ml and the average volume was about 5800ml. The severe postoperative complications included DIC, acute renal failure, multiple organ dysfunction syndrome, and no maternal death occurred. Perinatal infants were 13 cases, one of them was died. Conclusion Hysterectomy is one of the effective measures to treat the acute obstetrical hemorrahage. Some means, such as strengthening the screening and administration of pregnant women and puerperas at high risk, preventing the occurrence of severe complications and lowering the esarean birth rate, may reduce the incidence of the obstetrical hysterectomy.