冯小平　李玉梅　谭白菊　王英　黄冬梅　郭海峰

【摘要】 目的：回顧性分析笔者所在科82例难治性产后出血各种止血方法疗效和止血失败原因分析。方法：选取笔者所在科2010年

1月-2015年3月收治难治性产后出血产妇82例。其中填塞组 31例，包括条形纱布填塞或水囊填塞；缝合组23例，包括子宫加压联合B-Lynch缝合术或改良B-Lynch缝合术；结扎组18例，结扎双侧子宫动脉上行支，必要时结扎双侧动脉下行支；填塞和缝合组10例，同时使用宫内填塞和加压缝合。对各组止血效果进行对比和失败原因分析。结果：（1）四组止血有效率比较差异无统计学意义（P>0.05），82例产妇实施以上治疗后有效62例，止血失败20例；止血失败病例其中行联合治疗后有效11例，保守治疗失败后子宫切除术9例。（2）20例止血失败病例中瘢痕子宫12例，胎盘植入7例，凝血功能异常1例；子宫切除患者9例，其中瘢痕子宫4例，胎盘植入5例。结论：（1）基层医院通过常规手术止血可以有效的治疗难治性产后出血，必要时多种止血方式联合使用临床实践证明有效。（2）止血失败原因主要有瘢痕子宫、胎盘植入和凝血功能异常；基层医院凝血功能异常患者少，在无法开展介入治疗的医院，子宫切除是其他止血方式失败的最后手段，尤其是胎盘植入的产妇。

【关键词】 难治性产后出血； 止血方法； 止血失败； 子宫切除术； 疗效

中图分类号 R714.46 文献标识码 A 文章编号 1674-6805（2016）5-0006-03

【Abstract】 Objective：To discuss the 82 cases of intractable postpartum hemorrhage the hemostasis effect and analyze the hemostasis failure reason.Method：From January 2010 to March 2015，82 cases with refractory postpartum hemorrhage maternal in our department were analyzed retrospectively.Statistical methods of hemostasis and the number of cases，packing group 31 cases，including bar gauze packing or water bag packing；suture group（23 cases），including uterine compression joint B-Lynch suture or modified B-Lynch suture；ligation group（18 cases），bilateral ligation of the ascending branches of uterine artery，necessary ligating bilateral artery descending；packing and suturing group（10 cases），at the same time，the intrauterine tampon and compression suture.The hemostatic effect of each group were compared and the causes of failure were analyzed.Result：（1）The rate of effective in four groups had no significant differences （P>0.05）.82 cases were effective in 62 cases，20 cases failed to stop bleeding，11 cases were treated with combined therapy，9 cases were treated with conservative treatment.（2）20 cases of bleeding failure cases，12 cases of scar uterus，7 cases of placenta implantation，1 case of abnormal coagulation function，9 cases of uterine resection，including 4 cases of scar uterus，5 cases of placenta implantation.Conclusion：（1）The effective treatment of intractable postpartum hemorrhage can be effectively treated by routine operation of basic level hospitals.The clinical practice proved that the combination of multiple hemostasis methods should be effective in the treatment of intractable postpartum hemorrhage.（2）Hemostasis failure reasons are mainly scar uterus，placenta accreta and coagulation dysfunction；grass-roots hospital blood coagulation function disorder patients in cannot conduct interventional treatment in the hospital，hysterectomy is the final means failure of other methods of hemostasis，especially placenta implantation of maternity.

【Key words】 Intractable postpartum hemorrhage； Hemostasis method； Failure of hemostasis； Hysterectomy； Curative effect

First-authors address：The Peoples Hospital of Meishan City，Meishan 620010，China

doi：10.14033/j.cnki.cfmr.2016.5.003

产后出血是分娩期严重并发症，发生率为2%～3%，多发生在分娩后24小时内[1]，产后出血70%～80%的原因是宫缩乏力[2]，世卫组织2000年统计报道中指出产后出血占产妇死亡的25%[3]。难治……