李晓燕

[摘要] 目的 分析子宮动脉栓塞术与传统外科止血治疗难治性产后出血的临床效果及安全性。 方法 筛选的70例难治性产后出血病例，为2018年3月至2020年2月于本院分娩患者。以随机数字表法分组，每组各35例。对照组以传统外科止血治疗，包括宫腔填塞纱布、球囊压迫止血等;观察组采用子宫动脉栓塞术治疗，比较两种治疗方案的止血效果及安全性。 结果 观察组止血成功率明显高于对照组，子宫切除率低于对照组（P<0.05）;观察组止血时间早于对照组，输血量明显少于对照组（P<0.05）。观察组患者治疗并发症发生率2.9%，对照组为11.1%，观察组明显低于对照组（P<0.05）。观察组患者下床活动时间早于对照组，住院时间短于对照组，生活质量评分高于对照组（P<0.05）。 结论 与传统外科止血治疗相比，子宫动脉栓塞术治疗难治性产后出血止血效果更好，止血时间明显缩短，可有效减少对患者机体的损伤，且并发症少，避免了切除子宫的不良后果，临床效果和安全性有保证，应用价值高。

[关键词] 难治性产后出血;子宫动脉栓塞术;宫腔填塞纱布;球囊压迫止血;子宫切除术;止血效果;安全性

[中图分类号] R714.46          [文献标识码] B          [文章编号] 1673-9701（2021）13-0076-03

Clinical effect and safety of uterine artery embolization and traditional surgical hemostasis in the treatment of refractory postpartum hemorrhage

LI Xiaoyan

Department of Obstetrics and Gynecology， Xiangyang Hospital of Traditional Chinese Medicine Xiangyang National Rescarth Institute of Chinese Medicine， Xiangyang   441000， China

[Abstract] Objective To analyze the clinical effect and safety of uterine artery embolization and traditional surgical hemostasis in the treatment of refractory postpartum hemorrhage. Methods A total of 70 cases of refractory postpartum hemorrhage screened were delivered in our hospital from March 2018 to February 2020. They were divided into two groups by random number table method， with 35 cases in each group. The control group was treated with traditional surgical hemostasis， including intrauterine packing with gauze， balloon compression hemostasis， etc. The observation group was treated with uterine artery embolization. The hemostatic effect and safety of the two treatment schemes were compared. Results Compared with the control group， the success rate of hemostasis was higher and the hysterectomy rate was lower in the observation group（P<0.05）. The hemostasis time was earlier in the observation group than that in the control group， and the blood transfusion volume was less than that in the control group（P<0.05）. The incidence rate of treatment complications was 2.9% in the observation group， while that in the control group was 11.1%， which was even lower in the observation group（P<0.05）. The time of getting out of bed was earlier in the observation group that that in the control group， the hospitalization time was shorter in the observation group than that in the control group， and the score of the quality of life was higher in the observation group than that in the control group（P<0.05）. Conclusion Compared with traditional surgical hemostasis， uterine artery embolization has a better hemostasis effect， shorter hemostasis time， less damage to patients′ body， and fewer treatment complications， which can avoid adverse consequences of hysterectomy， and guarantee clinical effect and safety， with higher application value.

[Key words] Refractory postpartum hemorrhage; Uterine artery embolization; Intrauterine packing with gauze; Balloon compression hemostasis; Hysterectomy; Hemostatic effect; Safety

产后出血是造成产妇死亡的常见原因之一，难治性产后出血指的是胎儿娩出后1 h内，出血量超过1500 mL的一种产后出血现象[1]。难治性产后出血采用常规的子宫按摩、双合诊按压以及常规药物治疗，均难以达到有效止血效果，部分合并凝血功能障碍的患者，出血情况更加难以控制[2]。而一旦出现难治性产后出血，应立即实施全面生化检查，明确出血的诱因，以制定行之有效的治疗方案。宫腔填塞纱布以及球囊止血等为传统外科常用止血方法，但止血无效可引发失血性休克，为了保障患者安全，不得不采取子宫切除术治疗，对患者的负面影响非常大[3]。随着医疗技术的不断发展，子宫动脉栓塞术在临床上得以应用，该手术方式具有微创优势，对患者机体损伤小，还可有效发挥止血效果，术后并发症发生率低[4]。……