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目的探讨Bakri球囊填塞治疗剖宫产产后出血的效果及不良结局。方法选取2013年4月-2016年6月在宜昌市妇幼保健院进行剖宫产分娩且发生产后出血的产妇46例为研究对象,回顾治疗过程并将研究对象分为接受Bakri球囊填塞治疗的观察组22例和接受B-Lynch缝合治疗的对照组24例。比较两组产妇术中总出血量、术后2 h及24 h出血量、总输血量、产前及产后血流动力学参数水平和不良结局发生率的差异。结果观察组术中总出血量、术后2 h出血量、术后24 h出血量、总输血量均少于对照组,差异均有统计学意义(P<0.05);观察组产后2 h血流动力学参数收缩压(SBP)、舒张压(DBP)、血氧饱和度(Sp O2)水平均高于对照组,脉搏(HR)水平低于对照组,差异均有统计学意义(P<0.05);观察组外周血凝血功能指标凝血酶原时间(PT)、血浆凝血酶时间(TT)水平均低于对照组,纤维蛋白原(FIB)、D-二聚体(D-D)水平均高于对照组,差异均有统计学意义(P<0.05);观察组产后失血性休克、弥散性血管内凝血(DIC)、子宫全切、死亡等不良结局发生率均低于对照组,差异均有统计学意义(P<0.05)。结论 Bakri球囊填塞可减少剖宫产产后出血量,稳定产妇血流动力学状态及凝血功能,优化分娩结局。
Objective To investigate the effect and adverse outcome of Bakri balloon tamponade in treating cesarean section postpartum hemorrhage. Methods From April 2013 to June 2016, 46 maternal women who underwent cesarean delivery and postpartum hemorrhage in Yichang Maternal and Child Health Hospital were enrolled in this study. The course of treatment was reviewed and the subjects were divided into two groups: Twenty-two patients in the observation group and 24 patients in the control group received B-Lynch suture. The differences of total blood loss, postoperative 2 h and 24 h blood loss, total blood transfusion, prenatal and postnatal hemodynamic parameters and incidence of adverse outcomes were compared between the two groups. Results The total intraoperative blood loss, blood loss at 2 h after operation, blood loss at 24 h and total blood transfusion in the observation group were all less than those in the control group (P <0.05) The parameters of SBP, DBP and Sp O2 were higher than those of the control group, and the pulse rate was lower than that of the control group (P < 0.05). The prothrombin time (PT) and thromboplastin time (TT) of peripheral blood coagulation indexes in the observation group were lower than those in the control group, and the levels of fibrinogen (FIB) and D-dimer (P <0.05). The incidences of postpartum hemorrhagic shock, disseminated intravascular coagulation (DIC), total hysterectomy and death were all lower in the control group than those in the control group There was statistical significance (P <0.05). Conclusions Bakri balloon tamponade can reduce postpartum cesarean section postpartum hemorrhage volume, stabilize maternal hemodynamic status and coagulation function, and optimize delivery outcomes.