杨红英　胡芳　王萍

[摘要] 目的 探讨联合应用止血带、卡前列素氨丁三醇及低位B-Lynch缝合术以减少前置胎盘剖宫产产后出血的效果。 方法 回顾性分析2011年1月～2016年12月期间我院因前置胎盘行剖宫产终止妊娠的产妇65例，根据术中止血方法分组：30例术中行止血带、低位B-Lynch缝合术联合卡前列素氨丁三醇止血者为观察组，35例行传统“8”字形缝合联合缩宫素处理者为对照组，对比两组的临床效果。 结果 观察组的术中出血量及术后24 h出血量均顯著低于对照组（P<0.05），观察组的手术时间较对照组显著缩短（P<0.05）；观察组与对照组的子宫切除率比较（0.00% vs 2.86%），无显著性差异（P>0.05）。 结论 对前置胎盘剖宫产产妇应用止血带、卡前列素氨丁三醇及低位B-Lynch缝合术联合治疗可提高止血效果，减少产后出血，缩短手术时间，值得在临床上推广应用。

[关键词] 前置胎盘；剖宫产；产后出血；止血带；卡前列素氨丁三醇；低位B-Lynch缝合术

[中图分类号] R719.8 [文献标识码] B [文章编号] 1673-9701（2017）24-0079-03

[Abstract] Objective To explore the effect of the combined application of tourniquet， carboprost tromethamine combined with low-level B-Lynch suture on reducing postpartum hemorrhage of placenta previa Cesarean section. Methods 65 puerpera who were given termination of pregnancy by Cesarean section due to placenta previa in our hospital from January 2011 to December 2016 were retrospectively analyzed. According to the method of intraoperative hemostasis， the patients were divided into groups： 30 cases who were given intraoperative tourniquet， low-level B-Lynch suture combined with carboprost tromethamine for hemostasis were assigned to the observation group， and 35 cases who were given traditional "8"-shaped suture combined with oxytocin treatment were assigned to the control group. The clinical effects were compared between the two groups. Results The intraoperative amount of blood loss and the amount of postoperative 24 h blood loss in the observation group were significantly lower than those in the control group（P<0.05）. The operation time in the observation group was significantly shorter than that in the control group（P<0.05）； there was no significant difference between the observation group and the control group in the rate of uterine resection （0.00% vs 2.86%） （P>0.05）. Conclusion For the puerpera with placenta previa undergoing Cesarean section， the combination therapy of tourniquet， carboprost tromethamine combined with low-level B-Lynch suture can improve the hemostatic effect， reduce postpartum hemorrhage and shorten the operation time， which is worthy of clinical promotion and application.

[Key words] Placenta previa； Cesarean section； Postpartum hemmorhage； Carboprost tromethamine； Low-level B-lynch suture

前置胎盘是妊娠晚期大出血的主要原因之一，一次大量出血可能导致患者休克。产后出血作为妇产科较严重的并发症之一，一旦出现就会给产妇的生命带来严重的威胁，也会给其之后身体康复带来不利的影响[1]。剖宫产是目前临床处理前置胎盘的常用措施，但术中可能因胎盘剥离面过大、胎盘植入而造成出血量增加，术中面临大出血、输血的风险，严重时可能因大量出血而切除子宫[2]，甚至危及产妇生命。随着二胎政策的放开，高龄产妇、瘢痕子宫、多次妊娠等因素，前置胎盘的发生率呈上升的趋势。剖宫产手术数量的增加，产妇产后出血量增加的风险进一步扩大，采用常规的止血方法效果并不显著[3]。……