卢文琼 廖珊 陈小宁

[摘要] 目的 分析Bakri球囊与宫腔填塞联合双侧子宫动脉上行支结扎术（简称：宫腔填纱动脉结扎）在前置胎盘产后出血中的应用效果。 方法 选择我院2013年1月～2017年12月剖宫产术中前置胎盘产后出血63例。根据不同的治疗方法分为Bakri球囊组33例和宫腔填纱动脉结扎组30例。Bakri球囊组用Bakri球囊止血，宫腔填纱动脉结扎组用宫腔填纱联合双侧子宫动脉上行支结扎术止血；分析两组术中出血量、手术时间、术后24 h出血量，输血人数、子宫切除率的差异。 结果 Bakri球囊组术中出血量、输血人数明显低于宫腔填纱动脉结扎组（P<0.05），手术时间也明显低于宫腔填纱动脈结扎组（P<0.05），术后24 h两组出血量比较，差异无统计学意义（P>0.05）；Bakri球囊组全部止血成功，但宫腔填纱动脉结扎组两例术后需行子宫动脉栓塞；两组均无子宫切除。结论 Bakri球囊治疗前置胎盘产后出血操作简单、安全、有效；掌握操作技巧可缩短球囊操作时间，减少术中出血，对术后出现的大出血可随时应用，具有一定的临床推广价值。

[关键词] 前置胎盘出血；Bakri球囊；宫腔填纱；子宫动脉上行支结扎

[中图分类号] R714.4 [文献标识码] B [文章编号] 1673-9701（2018）15-0064-04

Clinical application of Bakri balloon in postpartum hemorrhage of placenta prepartum

LU Wenqiong LIAO Shan CHEN Xiaoning

Department of Obstetrics and Gynecology，the First People's Hospital of Foshan City in Guangdong Province， Foshan 528000，China

[Abstract] Objective To analyze the effect of Bakri balloon and intrauterine gauze packing combined with bilateral ligation of uterine artery ascending branch （abbreviation： intrauterine packing artery ligation） in postpartum hemorrhage of placenta previa. Methods We selected 63 cases of placenta previa hemorrhage during caesarean section from January 2013 to December 2017 in our hospital. Participants were divided into Bakri balloon group with 33 cases and intrauterine packing artery ligation group with 30 cases according to different treatment methods. In the Bakri balloon group， Bakri balloon was used to stop bleeding and intrauterine packing artery ligation group was treated with intrauterine gauze packing combined with bilateral ligation of uterine artery ascending branch to stop bleeding. Intraoperative blood loss， operation time， blood loss 24 hours after operation， number of blood transfusions and the rate of hysterectomy were analyzed. Results The blood loss and blood transfusion in the Bakri balloon group were significantly lower than those in the ligation group（P<0.05）. The operation time was also significantly lower than that in the ligation group（P<0.05）. There was no significant difference in blood loss 24 hours after operation between the two groups（P>0.05）. All patients in the Bakri balloon group stopped bleeding successfully， while 2 cases in the ligation group received uterine artery embolization. No hysterectomy was performed in both groups. Conclusion Bakri balloon for the treatment of postpartum hemorrhage of placenta previa is simple， safe and effective. Mastering operation skills can shorten the operation time of balloon and reduce intraoperative blood loss.It can be applied at any time for postoperative massive hemorrhage which is worthy of promotion in clinic.

[Key words] Placenta previa hemorrhage； Bakri balloon； Intrauterine gauze packing； Ascending uterine artery ligation

“前置胎盘”是妊娠28周后胎盘附着于子宫下段，下缘达到或覆盖宫颈内口，位置低于胎儿先露部，是妊娠中晚期严重影响母婴安全的并发症。随着我国二胎政策的放开、高龄孕妇增多及剖宫产率的居高不下，产后出血发病率明显上升，产后出血是我国孕产妇死亡的首要原因[1]，而前置胎盘是产后出血的主要原因之一，前置胎盘（特别是凶险性前置胎盘）剖宫产中因子宫下段收缩力差，创面大，出血迅速及凶猛，如止血不及时，需行子宫切除，给产妇造成巨大心理壓力。……