林琼 王钦 张秀芳

【摘要】 目的 探討宫腔球囊压迫与B-Lynch缝合止血对前置胎盘剖宫产产后出血的止血效果及应激指标的影响。

方法 选取2018年1月至2020年4月期间于莆田盛兴医院行剖宫产分娩的90例产后出血前置胎盘产妇，按照治疗方式不同分为压迫组（45例）和缝合组（45例）。压迫组予宫腔球囊压迫处理，缝合组行B-Lynch缝合止血。比较两组止血效果、产后2 h和24 h出血量、应激指标、并发症。

结果 压迫组止血有效率高于缝合组，产后2 h和24 h出血量少于缝合组，差异有统计学意义（P<0.05）;术后24 h，两组肾上腺素（E）、皮质醇（Cor）、去甲肾上腺素（NE）水平均高于术前，差异有统计学意义（P<0.05），术后24 h，压迫组E、Cor、NE水平低于缝合组，差异有统计学意义（P<0.05）;两组总并发症发生率相比，差异无统计学意义（P>0.05）。

结论 宫腔球囊压迫与B-Lynch缝合止血均是治疗前置胎盘剖宫产产后出血的安全性手段，但前者止血效果更好，能够减少产后出血量，减轻患者创伤应激状态，值得临床推广。

【关键词】 前置胎盘;宫腔球囊压迫;B-Lynch缝合;产后出血;创伤应激反应

中图分类号：R714.46+1   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.12.013

【Abstract】 Objective To investigate the hemostatic effect of uterine balloon compression and B-Lynch suture to stop bleeding after cesarean section with placenta previa and their influences on stress indicators.

Methods 90 pregnant women with postpartum hemorrhage and placenta previa who underwent cesarean section in Putian Shengxing Hospital from January 2018 to April 2020 were selected.   According to different treatment methods， they were divided into compression group （45 cases） and suture group （45 cases）. The compression group were treated with uterine balloon compression， and the suture group were treated with B-Lynch suture to stop bleeding. And then， the hemostatic effects as well as blood losses， stress indicators and complications at 2 h and 24 h after delivery were compared between the two groups.

Results The effective rate of hemostasis in the compression group was higher than that of the suture group， and the blood losses at 2 h and 24 h after delivery were lower than those of the suture group （P<0.05）. At 24 h after operation， the levels of adrenaline （E）， cortisol （Cor） and norepinephrine （NE） of the two groups were higher than those before operation， and the difference was statistically significant （P<0.05）. At 24 h after operation， the levels of E， Cor and NE in the compression group were lower than those in the suture group， and the difference was statistically significant （P<0.05）. There was no statistically significant difference in the total complication rate between the two groups （P>0.05）.

Conclusion Both uterine balloon compression and B-Lynch suture hemostasis are safe methods for the treatment of postpartum hemorrhage after cesarean section with placenta previa， but the former has better hemostasis effect， which can reduce postpartum hemorrhage and relieve the traumatic stress state of patients， and thus is worthy of promotion in clinical practice.

【Key words】 placenta previa; uterine balloon compression; B-Lynch suture; postpartum hemorrhage; traumatic stress response

前置胎盘的发生与孕妇年龄、妊娠次数、剖宫产、流产次数等因素有关，是妊娠期常见的并发症之一[1]。若处理不及时或处理不当，可引起胎儿宫内窘迫、早产、羊水栓塞、孕妇围产期大出血、新生儿窒息等不良情况，甚至危及母婴健康。剖宫产是前置胎盘患者终止妊娠的主要手段，但产后存在较高的出血风险，若出血未得到有效控制，需切除患者子宫[2]。如何安全、有效地控制产后出血是产科医护人员研究的热点。……