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目的探讨凶险性前置胎盘致产后大出血患者的急症子宫切除术的手术时机。方法选择2013年1月—2016年1月期间于南通市第一人民医院妇产科收治的凶险性前置胎盘并产后大出血患者70例,按照患者治疗方法不同分为观察组22例和对照组48例。对照组患者在剖宫产术中促宫缩治疗无法止血后,给予子宫切除术,观察组患者行子宫动脉栓塞术,期间观察患者出血量,若出血量仍较多,超过1 000 ml,上述措施无效,再给予子宫切除术。观察并比较2组患者的一般资料,子宫切除前出血量、术中总出血量、输血量、手术时间、住院时间、抗生素应用时间等手术情况及并发症发生情况。结果 2组患者一般资料比较差异无统计学意义(P>0.05)。观察组患者子宫切除前出血量、术中总出血量均显著多于对照组(P<0.05)。观察组患者新鲜冰冻血浆输注量显著高于对照组(P<0.05)。观察组手术时间长于对照组,差异有统计学意义(P<0.05)。但2组患者在住院时间、抗生素应用时间上比较,差异无统计学意义(P>0.05)。2组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论在保证血液供应及时及家属知情同意的基础上,凶险性前置胎盘致产后大出血患者可先行保守治疗再行子宫切除术,以尽量减少切除子宫对患者造成的伤害,同时,可为患者保留生育功能,但治疗过程中应密切监控患者出血情况,若经保守治疗仍无法止血应尽早进行子宫切除术。
Objective To investigate the timing of surgery for emergency hysterectomy in patients with postpartum hemorrhage due to dangerous placenta previa. Methods Seventy patients with dangerous placenta previa and postpartum hemorrhage admitted to the Obstetrics and Gynecology Department of Nantong First People’s Hospital from January 2013 to January 2016 were divided into observation group (22 cases) and control group 48 cases. Control group patients in the cesarean section in the treatment of uterine contractions can not stop bleeding, give hysterectomy, observation group patients underwent uterine arterial embolization during the observation of patients with bleeding, if the amount of bleeding is still more, more than 1 000 ml, the above Invalid measure, give hysterectomy again. Observe and compare the general information of two groups of patients, the amount of bleeding before hysterectomy, total blood loss during operation, blood transfusion, operation time, hospital stay, antibiotic application time and other complications and complications. Results There was no significant difference in general data between the two groups (P> 0.05). In the observation group, the amount of hemorrhage, the total amount of blood loss during hysterectomy were significantly more than those in the control group (P <0.05). The amount of fresh frozen plasma in observation group was significantly higher than that in control group (P <0.05). The operation time of observation group was longer than that of control group, the difference was statistically significant (P <0.05). However, there was no significant difference in the duration of hospitalization and antibiotic application between the two groups (P> 0.05). The incidence of postoperative complications in the two groups showed no significant difference (P> 0.05). Conclusions On the basis of timely informed consent of blood and family members, patients with post-partum haemorrhage leading to dangerous placenta previa may undergo conservative treatment followed by hysterectomy in order to minimize the harm caused to the patient after the removal of the uterus, and at the same time, they can be reserved for patients Reproductive function, but the treatment process should be closely monitored bleeding patients, if conservative treatment can not stop bleeding should be carried out as soon as possible hysterectomy.