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目的探讨剖宫产术中大出血的止血方法及出血原因,改善止血效果,降低大出血的发生率。方法 2009年2月—2013年2月,西平县人民医院妇产科因各种原因行剖宫产术3 552例,其中52例术中出血量≥1 000 mL。回顾性分析52例患者的临床资料。结果胎儿娩出后子宫收缩乏力(28例,占55.7%;切口撕裂4例,占7.7%)和胎盘因素(前置胎盘及胎盘早剥20例,占38.0%)是剖宫产术中大出血的主要原因。行子宫动脉上行支结扎术2例(3.7%),用可吸收线局部“8”字缝合子宫胎盘剥离面止血14例(26.9%),对宫缩乏力病例正确使用宫缩剂、及时缝合20例(38%),采用B-Lynch缝合术6例(11.5%),胎盘剥离面压迫止血的同时应用宫缩剂6例(11.5%),切口撕裂及时缝合4例。52例均成功止血,无1例患者因止血失败而切除子宫。结论胎儿娩出后子宫收缩乏力和胎盘因素是剖宫产术中大出血的主要原因。在补充血容量纠正休克的同时,迅速确定大出血的原因。针对大出血的原因采取相应的止血措施可有效降低子宫切除率和孕产妇的病死率。
Objective To investigate the method of hemostasis and bleeding causes of hemorrhage in cesarean section, to improve the hemostatic effect and reduce the incidence of major bleeding. Methods From February 2009 to February 2013, 3 552 cesarean sections were performed in Xipin County People’s Hospital for gynecology and obstetrics for various reasons, of which 52 cases had blood loss ≥1 000 mL. Retrospective analysis of 52 patients with clinical data. Results Uterine atony (28 cases, 55.7%; incision 4 cases, accounting for 7.7%) and placenta (placenta previa and placental abruption in 20 cases, accounting for 38.0%) were severe bleeding after cesarean section The main reason. Uterine artery ligation was performed in 2 cases (3.7%). 14 cases (26.9%) were sutured with absorbable line “8” Six cases (11.5%) were treated with B-Lynch suture (11.5%), while the contraceptive placenta surface was used for hemostasis. Four cases were sutured and sutured in time. All 52 cases were successfully hemostatic, and none of the patients had hysterectomy due to failure of hemostasis. Conclusions Fetal contractions and placental factors after fetal delivery are the major causes of major bleeding during cesarean section. In addition to correct the shock of blood volume at the same time, quickly determine the cause of bleeding. For the reasons for bleeding to take appropriate hemostatic measures can effectively reduce the hysterectomy rate and maternal mortality.