产后出血147例救治及临床研究.docVIP

产后出血147例救治及临床研究[摘要]目的：探讨产后大出血的治疗及产后大出血需手术的主要原因分析。方法：对147例产后大出血的病人进行回顾性分析，总结治疗方法及疗效；并对21例行手术止血的病人进行原因分析。结果：126（85.71%）例患者经保守治疗获得满意的止血效果，但是有21（14.29%）例因保守治疗无效或效果欠佳最终进行了手术止血治疗，其中因胎盘因素造成大出血的占15例，因子宫因素及产妇因素造成大出血的各3例。结论：产后大出血绝大多数可经保守治疗获得满意疗效，有少部分需手术治疗，这部分病人主要是因胎盘因素导致大出血，其次是产妇因素。 [关键词]产后出血；胎盘；子宫；保守治疗；手术治疗 [中图分类号]R714 [文献标识码]A [文章编号]1673-7210（2007）09（a）-035-02 The clinical analysis of 147 cases of Postpartum Hemorrhage XIANG Nu-tao1,ZHAO Hong-li1,CHEN Li-ying1,GUO Li-na1,KAN Qi-wei2 （1.The Second People Hospital of Meishan,Meishan 620010,China;2.West China Medical School Sichuan University,Chengdou 610041,China） [Abstract]Objective: To investigate the treatment of postpartum hemorrhage and causes that led to surgical treatment.Methods:147 patients who underwent postpartumhemorrhage were retrospectively studied the treatment methods，the curative effect and the predominant factors that resulted in surgical treatment in 21 patients.Results:There were 126(85.71%)patients with conservative treatment received satisfactory effect,and 21(14.29%)patients who were ineffective to conservative treatment had to accept surgical treatment.The cases of postpartum hemorrhage because of placenta factor,vomb factor and Parturient factor were 15,3 and 3 respectively.Conclusion:Conservative treatment methods are effective to overwhelming majority of patients with postpartum hemorrhage,only a minority of them need surgical treatment,whose hemorrhage hemorrhage mainly result from placenta factor,followed by Parturient factor. [Key words]Postpartum hemorrhage；Placenta；Vomb；Conservative treatment；Surgical treatment 产后出血是指从接生到胎儿娩出2 h内出血达到或超过400 ml，或至胎儿娩出24 h内出血量达到或超过500 ml[1]，是分娩期的严重并发症，居我国产妇死亡原因之首。本文对我院1997年3月~2007年3月收治的147例产后出血病例进行了回顾性分析，现报道如下： １ 资料与方法 1.1 一般资料 本组147例，125例在我院发病，22例为发病后由外院转入我院。年龄为19~38岁，平均32岁。孕周35~41周，平均39.1周。宫缩乏力56例，子宫肌瘤2例，子宫平滑肌瘤1例；胎盘粘连15例，胎盘前置16例，胎盘早剥28例，胎盘滞留或部分残留10例；妊娠高血压综合征5例，妊娠期肝内胆汁淤积症(ICP)4例，软产道损伤7例，多次剖宫产2例，凝血功能障碍1例。其中发生DIC 5例，急性肾功能衰竭4例，失血性休克1