子宫背带式缝合术对剖宫产产后出血的治疗效果及对术中出血量和下床活动时间的影响
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摘要
目的探究子宫背带式缝合术对剖宫产产后出血的治疗效果及对术中出血量和下床活动时间的影响。方法选取2013年3月至2017年9月扬州大学附属六合区人民医院诊治的、符合纳入标准的50例剖宫产患者为研究对象,按照不同治疗方法将其分为观察组和对照组,每组25例患者。观察组患者行子宫背带式缝合术治疗,对照组患者行传统填塞纱布治疗。分析并比较两组患者产后手术时间、术中出血量、下床活动时间。结果观察组患者手术时间、术中总出血量、下床活动时间、恶露持续时间和住院时间均低于对照组患者,其差异均具有统计学意义(t=6.58、17.49、7.77、4.99、10.24,均P<0.01);两组患者术后阴道出血量差异无统计学意义(t=1.59,P=0.12);观察组患者宫缩持续时间多于对照组患者,其差异具有统计学意义(t=3.99,P<0.01);随着时间的推移,两组患者子宫底下降高度均有所改善,其差异具有统计学意义(F=4.06,P=0.04);观察组患者子宫底下降高度均高于对照组患者,其差异具有统计学意义(F=5.57,P=0.02);观察组患者术后并发症发生率低于对照组患者,其差异具有统计学意义(χ~2=5.88,P=0.02)。结论子宫背带式缝合术能够有效降低剖宫产术中出血量,缩短手术时间和下床活动时间,值得临床推广。
Objective To explore the effect of B-lynch hysterorrhaphy for the treatment of postpartum hemorrhage of cesarean section, and its influence on intraoperative blood loss and workout time. Methods 50 patients with cesarean section in Liuhe People′s Hospital from March 2013 to September 2017, according to the treatment method, were divided into observation group(n=25) and control group(n=25). The observation group was treated by B-lynch hysterorrhaphy and the control group was treated with traditional gauze filling. The treatment effect, intraoperative blood loss and postoperative ambulation time of the two groups were analyzed and compared. Results The operation time, intraoperative blood loss, ambulation time and duration of lochia and hospitalization time in observation group were lower than those in the control group, all with statistically significant differences(t=6.58, 17.49, 7.77, 4.99, 10.24, all P<0.01). There was no significant difference in postoperative vaginal bleeding between the two groups(t=1.59, P=0.12). The duration of uterine contractions in the observation group was longer than that in the control group, with statistically significant difference(t=3.99, P<0.01). As time goes on, the descending height of the fundus in two groups improved, with statistically significant difference(F=4.06, P=0.04).The descending height of the fundus in the observation group was higher than that in the control group, with statistically significant difference(F=5.57, P=0.02). The incidence of postoperative complications in the observation group was lower than that in the control group(χ~2=5.88, P=0.02). Conclusions B-lynch hysterorrhaphy can effectively reduce the amount of intraoperative blood loss, shorten the operation time and ambulation time, which is worthy of clinical promotion.
Objective To explore the effect of B-lynch hysterorrhaphy for the treatment of postpartum hemorrhage of cesarean section, and its influence on intraoperative blood loss and workout time. Methods 50 patients with cesarean section in Liuhe People′s Hospital from March 2013 to September 2017, according to the treatment method, were divided into observation group(n=25) and control group(n=25). The observation group was treated by B-lynch hysterorrhaphy and the control group was treated with traditional gauze filling. The treatment effect, intraoperative blood loss and postoperative ambulation time of the two groups were analyzed and compared. Results The operation time, intraoperative blood loss, ambulation time and duration of lochia and hospitalization time in observation group were lower than those in the control group, all with statistically significant differences(t=6.58, 17.49, 7.77, 4.99, 10.24, all P<0.01). There was no significant difference in postoperative vaginal bleeding between the two groups(t=1.59, P=0.12). The duration of uterine contractions in the observation group was longer than that in the control group, with statistically significant difference(t=3.99, P<0.01). As time goes on, the descending height of the fundus in two groups improved, with statistically significant difference(F=4.06, P=0.04).The descending height of the fundus in the observation group was higher than that in the control group, with statistically significant difference(F=5.57, P=0.02). The incidence of postoperative complications in the observation group was lower than that in the control group(χ~2=5.88, P=0.02). Conclusions B-lynch hysterorrhaphy can effectively reduce the amount of intraoperative blood loss, shorten the operation time and ambulation time, which is worthy of clinical promotion.
引文
[1] Baba Y,Matsubara S,Ohkuchi A,et al.Anterior placentation as a risk factor for massive hemorrhage during cesarean section in patients with placenta previa[J].Journal of Obstetrics and Gynaecology Research,2014,40(5):1243-1248.
[2] Soyama H,Miyamoto M,Ishibashi H,et al.Relation between birth weight and intraoperative hemorrhage during cesarean section in pregnancy with placenta previa[J].PLOS ONE,2016,11(11):332-334.
[3] 何涓,刘月红,吉文倩.104例子宫背带式缝合术在剖宫产术后出血中的应用[J].重庆医学,2014,43(32):4372-4373.
[4] 李红梅.子宫背带式缝合术治疗在剖宫产术中对产后出血的效果评价[J].中国实用医药,2015,10(23):126-127.
[5] 孙丽洲,杨娜娜,刘丽萍.阴道分娩及剖宫产产后出血预警及防范[J].中国实用妇科与产科杂志,2014,30(4):259-262.
[6] Chaudhuri P,Mandi S,Mazumdar A.Rectally administrated misoprostol as an alternative to intravenous oxytocin infusion for preventing post-partum hemorrhage after cesarean delivery[J].Journal of Obstetrics and Gynaecology Research,2014,40(9):2023-2030.
[7] Deng L,Chang Q,Wang Y,et al.Tourniquet device for hemorrhage control during cesarean section of complete placenta previa pregnancies[J].Journal of Obstetrics and Gynaecology Research,2014,40(2):399-404.
[8] 何涓,刘月红,吉文倩.104例子宫背带式缝合术在剖宫产术后出血中的应用[J].重庆医学,2014,43(32):4372-4373.
[9] 陈咏玫,王静,李智.剖宫产术中内压缩缝合法用于中央性前置胎盘264例疗效分析[J].中国妇产科临床杂志,2017,18(2):149-152.
[10] 王瑞华.子宫背带式缝合术治疗剖宫产术中产后出血的效果[J].广东医学,2014,35(7):1062-1063.
[11] 刘洪莉,漆洪波,罗欣,等.子宫交叉捆绑术治疗剖宫产术中难治性产后出血疗效研究[J].中国实用妇科与产科杂志,2016,32(6):554-557.
[12] 孟钥.背带式缝合术治疗剖宫产产后出血的疗效和安全性分析[J].中国卫生产业,2014,11(30):144-145.
[13] 周岩,严滨.不同方法对剖宫产术后出血量的估计及出血量大于500ml的危险因素分析[J].实用妇产科杂志,2017,33(6):461-464.
[14] 邓瑛,刘大艳,王洁,等.剖宫产术中子宫收缩乏力性出血的手术止血方法及预后研究[J].中国妇幼保健,2014,29 (15):2330-2332.
[15] 张玉红.子宫背带式缝合术治疗剖宫产术中产后出血的可行性分析[J].重庆医学,2017,46(2):378-379.
[16] 季成美,刘金香,徐勤勤.难治性产后出血运用子宫背带缝合术配伍治疗的临床研究[J].中国卫生标准管理,2017,8(7):24-26.
[17] 徐琪.子宫背带式缝合术治疗剖宫产术中产后出血50例临床观察[J].中国卫生标准管理,2015,6(16):54-55.
[18] 任兰翠.剖宫产产后出血应用改良子宫背带式缝合术治疗的临床观察[J].中国现代药物应用,2016,10(5):81-82.
[2] Soyama H,Miyamoto M,Ishibashi H,et al.Relation between birth weight and intraoperative hemorrhage during cesarean section in pregnancy with placenta previa[J].PLOS ONE,2016,11(11):332-334.
[3] 何涓,刘月红,吉文倩.104例子宫背带式缝合术在剖宫产术后出血中的应用[J].重庆医学,2014,43(32):4372-4373.
[4] 李红梅.子宫背带式缝合术治疗在剖宫产术中对产后出血的效果评价[J].中国实用医药,2015,10(23):126-127.
[5] 孙丽洲,杨娜娜,刘丽萍.阴道分娩及剖宫产产后出血预警及防范[J].中国实用妇科与产科杂志,2014,30(4):259-262.
[6] Chaudhuri P,Mandi S,Mazumdar A.Rectally administrated misoprostol as an alternative to intravenous oxytocin infusion for preventing post-partum hemorrhage after cesarean delivery[J].Journal of Obstetrics and Gynaecology Research,2014,40(9):2023-2030.
[7] Deng L,Chang Q,Wang Y,et al.Tourniquet device for hemorrhage control during cesarean section of complete placenta previa pregnancies[J].Journal of Obstetrics and Gynaecology Research,2014,40(2):399-404.
[8] 何涓,刘月红,吉文倩.104例子宫背带式缝合术在剖宫产术后出血中的应用[J].重庆医学,2014,43(32):4372-4373.
[9] 陈咏玫,王静,李智.剖宫产术中内压缩缝合法用于中央性前置胎盘264例疗效分析[J].中国妇产科临床杂志,2017,18(2):149-152.
[10] 王瑞华.子宫背带式缝合术治疗剖宫产术中产后出血的效果[J].广东医学,2014,35(7):1062-1063.
[11] 刘洪莉,漆洪波,罗欣,等.子宫交叉捆绑术治疗剖宫产术中难治性产后出血疗效研究[J].中国实用妇科与产科杂志,2016,32(6):554-557.
[12] 孟钥.背带式缝合术治疗剖宫产产后出血的疗效和安全性分析[J].中国卫生产业,2014,11(30):144-145.
[13] 周岩,严滨.不同方法对剖宫产术后出血量的估计及出血量大于500ml的危险因素分析[J].实用妇产科杂志,2017,33(6):461-464.
[14] 邓瑛,刘大艳,王洁,等.剖宫产术中子宫收缩乏力性出血的手术止血方法及预后研究[J].中国妇幼保健,2014,29 (15):2330-2332.
[15] 张玉红.子宫背带式缝合术治疗剖宫产术中产后出血的可行性分析[J].重庆医学,2017,46(2):378-379.
[16] 季成美,刘金香,徐勤勤.难治性产后出血运用子宫背带缝合术配伍治疗的临床研究[J].中国卫生标准管理,2017,8(7):24-26.
[17] 徐琪.子宫背带式缝合术治疗剖宫产术中产后出血50例临床观察[J].中国卫生标准管理,2015,6(16):54-55.
[18] 任兰翠.剖宫产产后出血应用改良子宫背带式缝合术治疗的临床观察[J].中国现代药物应用,2016,10(5):81-82.