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目的探讨Bakri球囊在宫缩乏力性产后出血且药物止血失败孕妇临床应用中的脱落率及相关防脱落措施。方法选取2011年2月-2013年4月于该院分娩的5 000例孕妇为研究对象,回顾性分析其临床资料,记录宫缩乏力致产后出血人数、产后出血用药后止血失败人数及止血失败后行Bakri球囊止血但球囊脱落人数。回顾性分析2013年6月-2015年5月于该院分娩的66例宫缩乏力致产后出血且药物止血失败孕妇临床资料,根据再止血方案分为Bakri球囊组(A组,32例)和联合组(B组,34例)两组,其中A组予以Bakri球囊止血方案,B组予以Bakri球囊联合阴道填塞纱条方案。记录两组产妇平均手术时间、止血时间、24h阴道流血量、输血量、下床活动时间、总住院时间差异,对比其止血有效率、Bakri球囊脱落率、产褥病率、ICU入住率差异。结果 15 000例孕妇宫缩乏力致产后出血率为6.5%(325/5 000);产后出血用药后止血失败率为1.4%(70/5 000);止血失败后行Bakri球囊止血但球囊脱落率为0.3%(15/5 000)。2两组产妇平均手术时间、产褥病率及ICU入住率对比均无统计学意义(P>0.05);B组产妇平均止血时间、24 h阴道流血量、输血量、下床活动时间及总住院时间显著低于A组产妇(P<0.05);B组产妇止血有效率为97.1%,显著高于A组产妇的81.3%(P<0.05);B组产妇Bakri球囊脱落率为2.9%,显著低于A组产妇的18.8%(P<0.05)。结论对宫缩乏力致产后出血且药物止血失败孕妇予以单纯Bakri球囊止血方案,虽止血效果理想但存在一定脱落率,需引起临床重视;Bakri球囊联合阴道填塞纱条方案可有效降低脱落率,对改善止血效果有利。
Objective To investigate the rate of shedding of Bakri balloon in the clinical application of uterine atony and the anti-shedding measures in patients with uterine inertia and drug failure. Methods A total of 5 000 pregnant women who gave birth in this hospital from February 2011 to April 2013 were selected as the research objects. The clinical data were retrospectively analyzed. The number of postpartum hemorrhage due to uterine inertia was recorded. The number of hemostatic failures and the failure of hemostasis After Bakri balloon hemostasis but the number of balloon shedding. The clinical data of 66 pregnant women with uterine atony who died from labor due to uterine inertia were analyzed retrospectively from June 2013 to May 2015. The clinical data were divided into Bakri balloon group (A group, 32 cases) (Group B, n = 34). The patients in group A received Bakri balloon hemostasis and the group B received the combination of Bakri balloon and vaginal infusion gauze. The mean operative time, bleeding time, vaginal bleeding amount, blood transfusion volume, time of bed ambulation and total hospital stay were recorded. The effective rate of hemostasis, rate of Bakri balloon abortion, rate of puerperal obstruction, ICU occupancy rate were recorded . Results 15 000 pregnant women with uterine inertia caused by postpartum hemorrhage rate was 6.5% (325/5 000); postpartum hemorrhage bleeding failure rate was 1.4% (70/5 000); hemostasis failed Bakri balloon hemostasis but balloon The rate of shedding was 0.3% (15/5 000). There was no significant difference between the two groups in the average operative time, the rate of puerperal morbidity and the occupancy rate of ICU (P> 0.05). The average bleeding time, blood transfusion volume, time of bed ambulation, The hospitalization time was significantly lower in group B than in group A (P <0.05). The effective rate of hemostasis in group B was 97.1%, significantly higher than 81.3% in group A (P <0.05) , Which was significantly lower than 18.8% in group A (P <0.05). Conclusions A simple Bakri balloon hemostasis is given to pregnant women who have suffered from postpartum hemorrhage due to uterine inertia and have failed to stop the drug from stopping bleeding. Although the hemostatic effect is satisfactory but there is a certain degree of shedding, clinical attention should be paid to it. Bakri balloon combined with vaginal plug gauze can effectively reduce the rate of shedding , To improve the hemostatic effect.