本文選題：U型縫合 + 子宮壓迫縫合　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:探討山東大學(xué)齊魯醫(yī)院剖宮產(chǎn)術(shù)中發(fā)生難治性產(chǎn)后出血(PPH)的可能高危因素以及導(dǎo)致出血的主要原因。評(píng)估改良式多U型子宮壓迫縫合術(shù)對(duì)剖宮產(chǎn)術(shù)中難治性PPH患者的臨床治療效果及預(yù)后。方法:對(duì)山東大學(xué)齊魯醫(yī)院婦產(chǎn)科2013年1月至2016年3月收住院行剖宮產(chǎn)術(shù)治療的難治性PPH患者42例(出血組)及按1:3的匹配方式隨機(jī)抽取的126例未發(fā)生產(chǎn)后出血的正常剖宮產(chǎn)患者(正常組)的臨床資料進(jìn)行回顧性分析。出血組42例患者中經(jīng)常規(guī)處理(按壓子宮、縮宮素及欣母沛等促宮縮藥物的應(yīng)用、宮腔紗布或球囊壓迫填塞、子宮動(dòng)脈結(jié)扎、"8"字縫合、B-Lynch縫合等)無(wú)效而行改良式多U型子宮壓迫縫合術(shù)10例(以下簡(jiǎn)稱(chēng)多U型縫合術(shù))(縫合組),經(jīng)常規(guī)處理未行多U型縫合術(shù)的患者32例(常規(guī)組)。統(tǒng)計(jì)方法是采取SPSS 23.0統(tǒng)計(jì)學(xué)軟件進(jìn)行檢驗(yàn),主要包括卡方及非參數(shù)秩和檢驗(yàn)。結(jié)果:1、通過(guò)出血組42例與正常組126例產(chǎn)婦的臨床資料比較得知:難治性PPH的可能高危因素為高齡產(chǎn)婦(年齡≥35歲)、既往流產(chǎn)史、多次妊娠史、既往剖宮產(chǎn)手術(shù)史(P0.05);2、縫合組10例產(chǎn)婦中因胎盤(pán)因素導(dǎo)致的難治性PPH6例(占60%),常規(guī)組32例產(chǎn)婦由胎盤(pán)因素導(dǎo)致的出血28例(占87.5%),兩組均無(wú)凝血功能異常的發(fā)生,兩組出血原因的差異無(wú)意義(P0.05);3、縫合組的術(shù)中出血量、輸紅細(xì)胞量、麻醉后完整手術(shù)時(shí)間以及剖宮產(chǎn)術(shù)后住院天數(shù)分別為 2250.00±716.86ml、6.20±3.19U、120.50±21.79min、4.50±1.96d,常規(guī)組的術(shù)中出血量、輸紅細(xì)胞量、麻醉后完整手術(shù)時(shí)間以及剖宮產(chǎn)術(shù)后住院天數(shù)分別為 3510.00±1877.70ml、12.4±9.46U、148.83±62.74min、7.37±2.61d,差異有統(tǒng)計(jì)學(xué)意義(P0.05);4、縫合組10例患者術(shù)畢出血均被有效控制,均未行子宮切除術(shù),常規(guī)組行子宮切除術(shù)6例;5、隨訪縫合組10例患者,惡露消失時(shí)間均正常,停止哺乳后均恢復(fù)正常月經(jīng),復(fù)查超聲均未發(fā)現(xiàn)宮腔粘連等縫合相關(guān)并發(fā)癥,其中2例患者再次妊娠,已足月分娩1例,另外1例患者因術(shù)后不足1年妊娠而行流產(chǎn)術(shù)。結(jié)論:1、產(chǎn)婦高齡狀態(tài)(年齡≥35歲)、既往流產(chǎn)史、1次及以上妊娠史以及剖宮產(chǎn)手術(shù)史為出血的可能高危因素,應(yīng)對(duì)合并有上述危險(xiǎn)因素的孕產(chǎn)婦提高警惕,并做好預(yù)防措施。其中胎盤(pán)因素,尤其是兇險(xiǎn)性前置胎盤(pán)在難治性PPH中所占的比例逐漸增高。2、改良式多U型子宮壓迫縫合術(shù)是簡(jiǎn)便、有效、快速、安全的止血術(shù)式,成功率較高,術(shù)后并發(fā)癥少,非常適合于剖宮產(chǎn)術(shù)中其他止血方法不能奏效的緊急情況下應(yīng)用。該術(shù)式有利于保留患者的生育功能,極其適用于技術(shù)、血源及搶救設(shè)備不充足的基層醫(yī)院,是值得推廣及應(yīng)用的。
[Abstract]:Objective: to investigate the possible high risk factors of intractable postpartum hemorrhage (PPH) during cesarean section in Qilu Hospital of Shandong University and the main causes of PPH. To evaluate the clinical effect and prognosis of modified multiple U type suture for refractory PPH during cesarean section. Methods: from January 2013 to March 2016, 42 patients with refractory PPH who underwent cesarean section in Qilu Hospital of Shandong University (bleeding group) and 126 cases without postpartum hemorrhage were randomly selected according to the matching method of 1:3. The clinical data of patients with normal cesarean section (normal group) were analyzed retrospectively. In the bleeding group, 42 patients were treated by routine treatment (pressing uterus, oxytocin and Xinmu Pei, etc.) uterine gauze or balloon compression tamponade, Uterine artery ligation, "8" suture and B-Lynch suture were ineffective, and 10 cases were treated with modified multi-U suture (hereinafter referred to as multi-U suture) (suture group), and 32 cases (routine group) without multi-U suture. SPSS 23.0 software was used to test the statistical method, including chi-square and nonparametric rank sum test. Results by comparing the clinical data of 42 cases in bleeding group and 126 cases in normal group, the results showed that the risk factors of refractory PPH were elderly women (鈮，

本文編號(hào)：2052628