子宫体双侧弓形动脉缝扎术联合垂体后叶素在剖宫产术中宫缩乏力性产后出血中的应用

陈慧等

[摘要] 目的 探讨子宫体双侧弓形动脉缝扎术联合垂体后叶素治疗剖宫产术中子宫收缩乏力性产后出血的临床效果。 方法 收集2013年1月～2014年2月于肇庆市广宁县人民医院行剖宫产并因术中子宫收缩乏力导致产后出血的产妇52例，其中研究组30例产妇采用子宫体双侧弓形动脉缝扎术治疗，对照组22例给予宫腔内纱条填塞等常规治疗。比较两组产妇有效率、手术时间、出血量、止血时间及子宫切除率及不良反应发生情况。 结果 研究组产妇手术时间、出血量、止血时间及子宫切除率[（44.25±5.73）min、（826±325）mL、（4.37±1.35）min、0.0%]均显著低于对照组[（78.62±12.48）min、（1985±731）mL、（24.79±3.13）min、9.1%]，差异均有统计学意义（P < 0.05）；治疗后，研究组有效率为100.0%，高于对照组（40.9%），差异有统计学意义（P < 0.05）；术后研究组1例产妇诉胸闷，对照组2例产妇诉胸闷。 结论 采用子宫体双侧弓形动脉缝扎术，可以最大限度地减免产科急症子宫切除，更好地控制出血量，减少产后出血的发生，值得临床推广。

[关键词] 产后出血；子宫体双侧弓形动脉缝扎术；收缩乏力；垂体后叶素

[中图分类号] R719.8 [文献标识码] A [文章编号] 1673-7210（2015）05（b）-0074-04

Application of bilateral arcuate artery suture hemostasis of corpus uteri combined with hypophysin in postpartum hemorrhage caused by uterine inertia

CHEN Hui MO Zhimei CHEN Ling CHAO Yue'e

Department of Obstetrics and Gynecology， Guangning People's Hospital， Guangdong Province， Guangning 526300， China

[Abstract] Objective To explore the clinical effect of body of uterus suture ligation of bilateral arcuate artery combined with hypophysin on uterine atony postpartum hemorrhage. Methods 52 patients with uterine atony postpartum hemorrhage from January 2013 to February 2014 in Guangning People's Hospital were collected. 30 patients in research group were given the bilateral arcuate artery of uterus suture ligation， and 22 patients in the control group were given the conventional treatment such as article gauze packing. The clinical effects such as effective rate， operation time， amount of bleeding， hemostatic time， and uterine resection rate of two groups were observed. Results In research group， the operation time was （44.25±5.73） min， amount of bleeding was （826±325） mL， and hemostatic time was （4.37±1.35） min， the uterine resection rate was 0.0%， which were significantly higher than those of the control group [（78.62±12.48） min， （1985±731） mL， （24.79±3.13） min， 9.1%]， the differences were statistically significant （P < 0.05）. The effective rate of the research group was 100.0%， while 40.9% in the control group， the difference was statistically significant （P < 0.05）. 1 case in the research group was postoperative chest tightness， and 2 cases in control group were postoperative chest tightness. Conclusion The uterus suture ligation of bilateral arcuate artery showes maximum reduction of emergency obstetric hysterectomy， controlle the bleeding volume and reduce postpartum hemorrhage， which be worthy of clinical promotion.

[Key words] Uterine atony postpartum hemorrhage； Bilateral arcuate artery suture hemostasis； Atony； Hypophysin

产后出血是孕产妇死亡的主要原因之一，而造成产后出血的诱因包括子宫收缩乏力、前置胎盘、胎盘植入、软产道损伤以及凝血功能障碍等[1]。其中我国49.9%孕产妇死于产后出血[2]，由此可见及时有效处理子宫收缩乏力性产后出血，对于降低孕产妇死亡率非常重要。临床上产后出血处理原则为早期诊断、有效处理以及个体化治疗。产后出血治疗效果受产妇身体条件以及失血量的影响，失血不多或产妇身体素质好，经治疗后可痊愈；若出血量大而产妇又出现贫血或凝血功能不全，则大量失血同时并发凝血功能障碍，患者出现休克甚至死亡。有的产妇在产后大量出血后，由于缺血和缺氧会造成器官、组织以及细胞损伤或坏死，留下较严重后遗症，如席汉综合征患者出现闭经、无乳以及外生殖器萎缩等，患者身体和心理都造成很大的创伤[3]。……