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目的探讨卡前列素氨丁三醇注射液、宫腔纱条填塞及改良低位B-Lynch缝合术治疗前置胎盘致难治性产后出血(PPH)的临床疗效。方法选取重庆市计生医院2012年8月—2015年1月收治的前置胎盘致难治性PPH产妇56例,随机分为对照组(n=26)和观察组(n=30)。对照组产妇采用缩宫素及行“8”字间断缝合术治疗,观察组产妇采用卡前列素氨丁三醇注射液、宫腔纱条填塞及改良低位B-Lynch缝合术治疗。随访4~12个月,比较两组产妇术中出血量、术后24 h出血量、止血时间、血性恶露持续时间、月经恢复正常时间及预后。结果两组产妇术中出血量比较,差异无统计学意义(P>0.05);观察组产妇术后24 h出血量少于对照组,止血时间、血性恶露持续时间、月经恢复正常时间短于对照组(P<0.05)。两组产妇止血失败率比较,差异无统计学意义(P>0.05)。两组产妇均未出现晚期产后出血及产褥感染。结论采用卡前列素氨丁三醇注射液、宫腔纱条填塞及改良低位B-Lynch缝合术治疗前置胎盘致难治性PPH的临床效果确切,可协同发挥强效止血的作用,有利于产后子宫复旧。
Objective To investigate the curative effect of treatment of refractory postpartum hemorrhage (PPH) with cardoprost trometamol injection, intrauterine sliver packing and modified low B-Lynch suture in the treatment of placenta previa. Methods Fifty-six pregnant women with refractory PPH who were treated with placenta accreta in Chongqing Family Planning Hospital from August 2012 to January 2015 were randomly divided into control group (n = 26) and observation group (n = 30). The control group maternal use of oxytocin and line “8 ” word intermittent suture treatment, observation group maternal use of carboprost trometamol injection, uterine gauze packing and modified low B-Lynch suture treatment. The patients were followed up for 4 to 12 months. The bleeding volume, bleeding volume, hemostatic time, bloody lochia duration, normal menstruation recovery time and prognosis were compared between the two groups. Results The bleeding volume in the two groups was no significant difference (P> 0.05). The bleeding volume of the observation group was less than that of the control group 24 h after operation, and the bleeding time, the duration of bloody lochia and the normal menstruation recovery time were shorter than those of the control group Group (P <0.05). There was no significant difference in the failure rate of hemostasis between the two groups (P> 0.05). Two groups of mothers did not appear late postpartum hemorrhage and puerperal infection. Conclusions The clinical effect of using carboprost trometamol injection, intrauterine sachet packing and modified low B-Lynch suture in the treatment of refractory PPH caused by placenta previa is exact and synergistic to exert the effect of powerful hemostasis, which is in favor of Postpartum uterine involution.