彭娟丽

【摘要】 目的：探究Bakri球囊填塞與B-Lynch缝合治疗剖宫产产后出血的临床效果及对血流动力学指标、性激素水平的影响。方法：选取笔者所在医院2016年5月-2018年6月收治的行剖宫产手术产后出血的产妇47例，按照治疗方法不同分为缝合组23例和填塞组24例。缝合组孕妇接受B-Lynch缝合治疗产后出血，填塞组孕妇接受Bakri球囊填塞治疗。比较两组术中出血量、术后2 h出血量、术后24 h出血量、总输血量、血流动力学指标变化及不良结局发生率。结果：填塞组术中出血量、术后2 h出血量及输血量均显著少于缝合组，差异有统计学意义（P<0.05）;两组产妇产前血流动力学指标比较差异无统计学意义（P>0.05），术后2 h观察发现，缝合组收缩压、舒张压、心率均显著高于填塞组，血氧饱和度显著低于填塞组，差异有统计学意义（P<0.05）;两组产妇手术前性激素水平比较差异无统计学意义（P>0.05），手术后6周，填塞组FSH、LH水平显著高于缝合组，差异均有统计学意义（P<0.05）;填塞组不良结局发生率显著低于缝合组，差异有统计学意义（P<0.05）。结论：Bakri球囊填塞治疗剖宫产产后出血具有较好的临床效果，能有效减少术中出血量、术后出血量，改善血流动力学指标，有效提高性激素水平，安全可靠。

【关键词】 球囊填塞; 剖宫产; 产后出血; 回顾性分析

doi：10.14033/j.cnki.cfmr.2019.27.058 文献标识码 B 文章编号 1674-6805（2019）26-0-03

Effect of Bakri Balloon Packing and B-Lynch Suture on Postpartum Hemorrhage，Hemodynamics and Sex Hormone Levels after Cesarean Section/PENG Juanli.//Chinese and Foreign Medical Research，2019，17（27）：-137

【Abstract】 Objective：To study the clinical effect of Bakri blloon packing combined with B-Lynch suture on postpartum hemorrhage after cesarean section and its influence on hemodynamic parameters and sex stimulin levels.Method：A total of 47 maternal with intrauterine hemorrhage from May 2016 to June 2018 were selected and divided into the suture group（23 cases） and the tamponade group（24 cases） according to different treatment methods.Pregnant women in the suture group received B-Lynch suture for postpartum hemorrhage，while those in the tamponade group received Bakri balloon tamponade.The amount of bleeding during operation，2 hours after operation，24 hours after operation，total blood transfusion，changes of hemodynamic parameters and incidence of adverse outcomes were compared between the two groups.Result：The intraoperative bleeding volume，2 hours postoperatively bleeding volume and blood transfusion volume in the tamponade group were significantly less than those in the suture group，the differences were statistical significance（P<0.05）.There was no significant difference in the hemodynamic indexes before delivery between the two groups（P>0.05）.Observations at 2 hours after delivery showed that systolic pressure，diastolic pressure and heart rate in the suture group were significantly higher than those in the tamponade group，blood oxygen saturation was significantly lower than that of tamponade group，the differences were significant（P<0.05）.There was no significant difference in sex hormone levels between the two groups before operation（P>0.05）.The FSH and LH levels in the tamponade group were significantly higher than those in the suture group 6 weeks after operation（P<0.05）.The incidence of poor outcomes in the tamponade group was significantly lower than that in the suture group（P<0.05）.Conclusion：Bakri balloon tamponade has a good clinical effect in the treatment of postpartum hemorrhage after cesarean section.It can effectively reduce the amount of intraoperative hemorrhage and postoperative hemorrhage，improve hemodynamic parameters，effectively raise the level of sex hormones.It is safe and reliable.

【Key words】 Ball plug; Caesarean section; Postpartum hemorrhage; Retrospective analysis

First-authors address：Fuyong Peoples Hospital in Baoan District of Shenzhen，Shenzhen 518103，China

产后出血是导致全球范围内孕产妇死亡的首要原因，2012年数据显示，产后出血占产妇死亡原因比例的27.0%[1]。虽然近年来随着诊断与治疗方法不断提高，产后出血的发生率也逐年降低，但仍然是值得重点关注的产科问题。产后出血定义为经阴道分娩者24 h内出血量≥500 ml，剖宫产产妇24 h内出血量≥1 000 ml。造成產后出血的高危因素主要为宫缩乏力（70%～90%）、产道损伤（20%）、胎盘因素（10%）及凝血功能障碍（1%）[2]。产后出血的治疗手段主要为补充血容量、子宫按摩或压迫、宫缩剂及化学药物如卡前列素氨丁三醇治疗[3]。笔者所在医院治疗剖宫产产后出血主要采取Bakri球囊填塞与B-Lynch缝合治疗，球囊填塞设计符合子宫内部形态，膨胀后能有效压迫止血，具有压迫面积广、止血迅速、操作简单的优势。……