难治性产后出血的止血方法比较

贾建楼1 ，孔雪玲2

（1.洛川县妇幼保健院，陕西 延安，727400；2.延安大学附属医院，陕西 延安，716099）

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摘要：

目的 比较各种止血方法在难治性产后出血治疗中的价值。方法 按照止血方法将我院收治的192例难治性产后出血患者分为宫腔塞纱70例（填塞组），盆腔动脉结扎24例（结扎组），经导管动脉栓塞（TAE）18例（介入组），子宫压迫缝合52例（缝合组），子宫压迫缝合+宫腔塞纱（缝合+填塞组）28例。对患者的总体治疗情况进行观察，并分析比较各组患者的止血情况及治疗结局。结果 192 例患者中142例患者止血成功，50例止血失败。介入组术前出血量多于其余各组（P<0.05），术中出血量、手术时间显著少于其余四组（P<0.05），止血成功率（100.0%）显著高于其余各组（P<0.05），其余各组止血成功率无显著性差异（P>0.05）；介入组子宫切除率显著低于其余各组（P<0.05）。结论各种止血手术对于难治性产后出血均有良好的止血效果，而TAE术具有手术时间短、术中出血少、止血成功率高的优势。

关键词：难治性产后出血；止血；子宫压迫缝合

中图分类号：R719.8文献标志码：A文章编号：2096-1413(2017)26-0128-02

Comparison of hemostasis methods in intractable postpartum hemorrhage
JIA Jian-lou 1, KONG Xue-ling 2
（1. Luochuan County Maternal and Child Health Care Hospital, Yan``an 727400; 2. Affiliated Hospital of Yan``an University,
Yan``an 716099, China）

ABSTRACT: Objective To compare the application value of various hemostasis methods in intractable postpartum hemorrhage. Methods One hundred and niney-two patients suffered from intractable postpartum hemorrhage in our hospital were divided into uterine tamponade (tamponade group, 70 cases), pelvic blood vessels ligation (1igation group, 24 cases), pelvical arterial embolization (TAE) (embolization group, 18 cases), uterine compression sutures (sutures group, 52 cases) and uterine compression sutures combining tamponade (combined group, 28 cases). The overall treatment were observed, hemostasis and treatment outcome of five group were analyzed and compared. Results Of 192 patients, 142 cases had a succeed hemostasis after received these treatments, while 50 cases failed. The blood loss before hemostasis surgery of the embolization group was greater than those of the other groups (P<0.05). The blood loss during the hemostasis surgery of the embolization group was less than those of the other groups (P<0.05). The operation time of the embolization group was shorter than those of other groups (P<0.05). The hemostasis success rate of the embolization group (100.0%) was higher than those of the other groups (P<0.05), while there were no significant differences between the other groups (P>0.05). The hysterectomy rate of embolization group was significantly less than those of the other groups (P<0.05). Conclusion Such hemostatic surgeries mentioned above were all effective, TEA has the comparative advantage of shorter operating time, less operating blood loss and higher success rate.
KEYWORDS: intractable postpartum hemorrhage; hemostasis; uterine compression suture

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