莫秋 吴桂芳 叶丽娟

【摘要】 目的：分析欣母沛聯合球囊填塞治疗前置胎盘剖宫产产后出血的临床效果。方法：回顾性分析南方医科大学附属小榄医院妇产科2015年1月-2017年12月住院的60例前置胎盘剖宫产产后出血≥500 mL的产妇的临床资料，根据不同的治疗方法将其分为对照组和观察组，各30例。对照组给予欣母沛治疗，观察组给予欣母沛联合球囊填塞治疗。观察两组产妇术中和术后2、24 h出血量和手术时间、住院时间，比较其临床疗效与不良反应发生情况。结果：观察组产妇的术中和术后2、24 h出血量均明显少于对照组，手术时间、住院时间均明显短于对照组，差异均有统计学意义（t=4.07、5.89、9.09、7.21、8.03，P<0.01）。观察组的总有效率为93.33%，明显高于对照组的73.33%，差异有统计学意义（字2=5.94，P<0.05）。两组产妇术中及术后过程均未发生严重的不良反应，未经治疗症状均自行消失。结论：欣母沛联合球囊填塞治疗前置胎盘剖宫产产后出血效果显著，安全性高，可有效减少产后出血量，缩短手术时间及住院时间，提高治疗总有效率，值得临床推广应用。

【关键词】 前置胎盘； 剖宫产； 产后出血； 欣母沛； 球囊填塞

【Abstract】 Objective：To analyse the clinical effect of Hemabate combined with balloon tamponade in the treatment of postpartum hemorrhage of placenta praevia cesarean section.Method：The clinical data of

60 parturients with placenta previa cesarean section postpartum hemorrhage more than 500 mL hospitalized from January 2015 to December 2017 in the Department of Obstetrics and Gynecology of Xiaolan Hospital Affiliated to Southern Medical University were retrospectively analyzed.According to different treatment methods，they were divided into control group and observation group，30 cases in each group.The control group was treated with Hemabate treatment，the observation group was treated with Hemabate combined with balloon tamponade treatment.The intraoperative， postoperative 2，24 h bleeding volume，operation time and hospital stay time were observed and the clinical efficacy and adverse reactions were compared between two groups.Result：The intraoperative，postoperative 2，24 h bleeding volume of the observation group were significantly less than those of the control group，operation time and hospital stay time were significantly shorter than those of the control group，the differences were statistically significant（t=4.07，5.89，9.09，7.21， 8.03，P<0.01）.The total effective rate of the observation group was 93.33%， which was significantly higher than 73.33% of the control group，the difference was statistically significant （字2=5.94，P<0.05）.There were no serious adverse reactions in the two groups of parturients during and after the operation，and the symptoms disappeared spontaneously without treatment.Conclusion：The combination of Hemabate and balloon tamponade has significant effect in the treatment of placenta previa cesarean section postpartum hemorrhage with high safety，it can effectively reduce the amount of postpartum hemorrhage，shorten the operation time and hospitalization time，improve the total effective rate，which is worthy of clinical application.

【Key words】 Placenta praevia； Cesarean section； Postpartum hemorrhage； Hemabate； Balloon tamponade

First-authors address：Xiaolan Hospital Affiliated to Southern Medical University，Zhongshan 528415，China

doi：10.3969/j.issn.1674-4985.2018.20.033

前置胎盘作为妊娠期严重的并发症，是指妊娠28周后，胎盘附着于子宫下段甚至胎盘下缘达到或覆盖宫颈内口，位置低于胎先露部，是造成妊娠晚期出血的主要原因之一[1]。目前剖宫产术是前置胎盘产妇进行分娩的主要方式，而产后极易出现大出血现象，若得不到及时有效的治疗，极易诱发感染、休克等并发症，严重者危及产妇生命。因此，如何预防或减少前置胎盘剖宫产产后出血具有重要的临床意义。研究表明，前置胎盘产后出血的主要原因是由于子宫收缩乏力，开放的血窦无法闭合[2]。欣母沛（卡前列素氨丁三醇）作为天然的前列腺素，具有持久促进子宫收缩和增加子宫平滑肌张力的作用，对于产后出血具有较好的治疗效果[3]。……