林淑鑫

[關键词] 难治性产后出血;前置胎盘;低位子宫背带式缝合术;卡前列素氨丁三醇

[中图分类号] R719.8          [文献标识码] B          [文章编号] 1673-9701（2021）14-0073-03

Efficacy of low uterine brace suture combined with carboprost tromethamine in treatment of refractory postpartum hemorrhage induced by placenta previa

LIN  Shuxin

Department of Obstetrics， Fuzhou Second Hospital， Fuzhou   350000， China

[Abstract] Objective To explore the clinical efficacy of low uterine brace suture combined with carboprost tromethamine in the treatment of refractory postpartum hemorrhage induced by placenta previa. Methods Eighty-two patients with refractory postpartum hemorrhage induced by placenta previa admitted to Department of Obstetric of our hospital from March 2017 to June 2020 were selected. They were divided into the observation group and the control group according to the order of admission， with 41 patients in each group. The control group were treated with "8" intermittent suture combined with oxytocin， while the observation group were treated with low uterine brace suture combined with carboprost tromethamine. The blood loss， postoperative recovery related indicators and clinical efficacy were compared between the two groups. Results The blood losses 2 h and 24 h after surgery of the observation group were （63.4±11.7） mL and （35.2±9.4） mL， which were less than those of the control group as （84.2±18.8） mL and （62.3±15.1）mL， with statistically significant differences（t=6.015， 9.756， P<0.05）. The time of postoperative off-bed exercise， hospitalization time， lochia duration and uterine involution time of the observation group were（2.8±0.7）d， （6.1±1.3）d， （14.0±3.4）d，  and （36.4±1.8）d， which were shorter than those of the control group as （4.6±1.1）d， （8.4±1.8）d， （19.7±4.6）d and （41.2±2.3）d， with statistically significant differences （t=8.840， 6.633， 6.381， 10.523， P<0.05）. The total clinical effective rate of the observation group was 95.2%， which was higher than that of the control group as 80.5%， with statistically significant difference（χ2=4.100， P<0.05）. Conclusion Lower uterine brace suture combined with carboprost tromethamine shows good clinical efficacy in the treatment of refractory postpartum hemorrhage induced by placenta previa， which can effectively control the bleeding and promote the recovery of patients.

[Key words] Refractory postpartum hemorrhage; Placenta previa; Low uterine brace suture; Carboprost tromethamine

产后出血是产妇常见的一种产后并发症，其中前置胎盘产妇剖宫产后出血的风险较高，患者若得不到及时有效的救治，易诱发成难治性产后出血，可导致血管内凝血、失血性休克等严重并发症，进而威胁患者生命安全[1]。目前产科治疗产后出血的方法较多，主要包括宫腔填纱、子宫按摩、使用缩宫素、卡前列素氨丁三醇及缝合手术等[2]，不论采用何种治疗手段，快速止血是临床救治的关键。前置胎盘致难治性产后出血病情进展较快，出血量多，出血控制难度大，产科处理相对棘手，需及时接受手术缝合联合药物止血治疗，但不同治疗方式的疗效可能存在差异，且临床应用各有利弊，寻找更有效的止血治疗方案是产科工作的难点和重点。本文将结合我院实际，着重探讨低位子宫背带式缝合术联合卡前列素氨丁三醇治疗前置胎盘性难治性产后出血的临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

选择福州市第二醫院2017年3月至2020年6月间收治的82例前置胎盘性难治性产后出血患者，纳入标准：（1）术前经超声检查确诊前置胎盘，有行剖宫产手术指征;（2）满足《妇产科学》（第8版）[3]中“前置胎盘致难治性产后出血”的诊断标准：①产后1 h内出血量>1000 mL;②经过子宫按摩、缩宫素等常规处理后仍无法有效止血;③出血致凝血障碍或器官脏器功能衰竭。出……