陈丽 王玲 石磊 李华

[摘要] 目的 探討子宫压缩性缝合术在剖宫产术产后出血治疗中的安全性。 方法 选择2010年1月～2014年12月重庆市江津区中心医院（以下简称“我院”）产科行剖宫术并发生产后大出血的30例患者为研究对象，所有患者均在给予缩宫素、按摩子宫等对症处理无效后给予子宫压缩性缝合术治疗，将其设为观察组。选择同期于我院产科行剖宫产术的产妇30例为对照组，所有患者均顺利完成剖宫产术，术中未发生大出血。术前、术后3 d、术后7 d分别检测患者血清C-反应蛋白（CRP）、白细胞（WBC）、中性粒细胞（N）、血红蛋白（Hb）水平；术后7 d、42 d、3个月采用B超及术后42 d采用宫腔镜检查了解患者的子宫恢复情况；随访观察患者产后月经、妊娠情况及妊娠结局。 结果 术后3 d，两组患者CRP、WBC、N均较术前升高（P < 0.05），术后7 d明显降低，与术后3 d比较，差异均有统计学意义（P < 0.05或P < 0.01），而与术前比较，差异均无统计学意义（P > 0.05）。手术前后，对照组患者Hb水平无明显变化（P > 0.05）；术后3、7 d观察组患者Hb水平均较对照组及本组治疗前明显降低（P < 0.05或P < 0.01）；术后7 d观察组患者的Hb水平逐渐恢复，较术后3 d明显升高（P < 0.05）。所有患者均于产后2～7周恶露干净，产后B超及宫腔镜检查显示子宫恢复良好，无宫腔粘连、缝线残留、子宫局部坏死。产后3～15个月恢复月经，两组均有1例患者发生痛经，经量及周期均正常。产后两组均有患者再次妊娠，均妊娠至足月后行剖宫产术顺利分娩。 结论 子宫压缩性缝合术在剖宫产术产后大出血治疗中效果显著，术后子宫恢复好，并发症发生少，安全性高，值得临床推广应用。

[关键词] 子宫压缩性缝合术；剖宫产；产后出血；安全性

[中图分类号] R719.8 [文献标识码] A [文章编号] 1673-7210（2016）03（c）-0124-04

[Abstract] Objective To explore the security of uterine compression sutures technique in the treatment of postpartum hemorrhage. Methods From January 2010 to December 2014， 30 patients with postpartum hemorrhage after cesarean section in Jiangjin Center Hospital of Chongqing （"our hospital" for short） were chosen as the observation group， all the patients were given the uterine compression sutures technique after the treatment of symptomatic treatment of oxytocin， massage womb， and had no effect. In the same period， 30 patients with cesarean section in our hospital were selected as the control group， all the patients were given successful cesarean section and without intraoperative bleeding. Before and 3， 7 d after operation， levels of serum hypersensitive C-reactive protein （CRP）， hemoglobin （Hb）， neutrophils， white blood cell （WBC） of patients were detected respectively； ultrasound of 7 d， 42 d， 3 months after operation and hysteroscopy of 42 d after operation were used to check the uterine recovery of patients； postpartum menstruation， pregnancy and pregnancy outcome of patients were observed in follow-up. Results 3 d after operation， levels of CRP， WBC， neutrophils of the two groups were elevated， compared with those before operation （P < 0.05）， and significantly reduced 7 d after operation， compared with the postoperative 3 d， the differences were statistically significant （P < 0.05 or P < 0.01）， and compared with the preoperative， there was no statistically significant difference （P > 0.05）. Before and after operation， Hb of the control group had no significant changes （P > 0.05）； 3， 7 d after operation， Hb of the observation group was significantly decreased compared with the control group and before operation （P < 0.05 or P < 0.01）； 7 d after operation， level of Hb in the observation group was gradually restored， increased significantly compared with 3 d after operation （P < 0.05）. Lochia of all patients was cleaned 2-7 weeks after operation， postpartum ultrasound and hysteroscopy examination showed that uterine recovery well， no local necrosis， intrauterine adhesions， suture residue， uterus partial necrosis. Menstruation recovery at 3-15 months after operation， both two groups had one patient with dysmenorrhea， the quantity and cycle were normal. There were pregnant patients in both two groups after operation， and delivery successfully by cesarean section. Conclusion Uterine compression sutures technique is effective in the treatment of postpartum hemorrhage during cesarean section， well recover postoperative uterine， less complications， high safety， worthy of clinical popularization and application.

[Key words] Uterine compression sutures technique； Cesarean section； Postpartum hemorrhage； Security

改善孕产妇健康是2000年联合国千年峰会时国际社会通过的8个千年发展目标之一。孕产妇死亡率是衡量一个国家或地区社会进步和经济发展的敏感指标，据估计，世界范围内，每年有14万妇女死于产后出血，每4分钟有1例孕产妇死亡，2005年产后出血占全世界孕产妇死因的25%，位居首位[1]。同样，产后出血也是我国孕产妇的第一死因，宫缩乏力是产后出血最常见的原因，占70%～75%[2]，因此针对该因素采取积极有效的处理措施对抢救产妇的生命，降低各种并发症显得非常重要。目前……