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剖宫产大出血74例临床分析及防治研究(1)
http://www.100md.com 2008年1月1日 《中外健康文摘·临床医师》 2008年第1期
剖宫产大出血74例临床分析及防治研究

     【中图分类号】R714.46+1 【文献标识码】B 【文章编号】1672-5085(2008)01-0011-02

    【摘要】目的:探讨剖宫产术中大出血的相关因素和防治措施,有利于减少产后出血的发生,提高孕产妇的健康水平。方法:通过我院1999年1月~2003年12月剖宫产术中大出血74例及同期阴道分娩产后出血病例临床资料,对出血原因、出血量进行对比分析。结果:剖宫产术中大出血发生率与平产相近,但出血量有显著性差异,在严重产后出血中占重要比例(70.4%)。出血原因主要是子宫收缩乏力和胎盘因素,二者比较有显著性差异,但前置胎盘所致术中出血占较高比例(32.43%)。结论:剖宫产术是严重产后出血的危险因素,降低剖宫产率,预防和治疗子宫收缩乏力和胎盘因素,特别是前置胎盘的术中出血是减少产后出血,提高孕产妇健康平安的重要措施。

    【关键词】剖宫产;产后出血;防治措施

    Splits the palace to produce the massive hemorrhage 74 examples clinical analyses and the preventing and controlling research Luo Ping
, 百拇医药
    【Abstract】Objective:The discussion splits the palace to produce in the technique the massive hemorrhage correlation factor and the preventing and controlling measure, is advantageous to the reduced post-natal hemorrhage occurrence, raises pregnant woman’s health standard. Method: In January, 1999~2003 year in December splits the palace through my courtyard to produce in the technique the massive hemorrhage 74 examples and the same time vaginas childbirth post-natal hemorrhage case of illness clinical material, to bleeds the reason, the hemorrhage quantity carries on the contrast analysis. Finally: Splits the palace to produce in the technique the massive hemorrhage formation rate and the equal output is close, but the hemorrhage quantity has significancethe difference, accounts for the important proportion in the serious post-natal hemorrhage (70.4%). The hemorrhage reason mainly is the womb contraction feels weak with the placenta factor, the two comparison has significancethe difference, but the pretage placenta is the result of in the technique to bleed accounts for a higher proportion (32.43%). Conclusion: Splits the palace to produce the technique is the serious post-natal hemorrhage dangerous factor, reduces splits the palace production rate, the prevention and the treatment womb contraction feels weak with the placenta factor, specially in the pretage placenta technique the hemorrhage is the reduced post-natal hemorrhage, enhances the pregnant woman health safe important measure.
, 百拇医药
    【Key words】Splits the palace to produce; Post-natal hemorrhage; Preventing and controlling measure

    产后出血是分娩期严重并发症,居我国目前孕产妇死亡原因的首位。剖宫产术是解决难产的有效措施,而剖宫产时的产后出血一般均较阴道分娩者多,病情危急,常危及产妇生命,必须分析原因,当机立断,迅速采取有效的止血措施。本文通过回顾性研究分析我院1999年1月-2003年12月发生剖宫产术中大出血74例,进一步探讨剖宫产术中出血相关因素及防治措施。

    1 临床资料

    1.1 我院5年内住院分娩产妇3644例,发生产后出血172例,产后出血发生率为4.7%,严重产后出血27例。剖宫产1689例,术中大出血74例,发生率4.38%,严重产后出血19例。平产1759例,产后出血20例,发生率4.54%,阴道助产196例,产后出血18例,发生率9.17%。
, http://www.100md.com
    1.2 一般情况:74例剖宫产术中出血产妇年龄0~40岁,平均28.4岁;孕周33+6~42+6周,平均38周;初产妇52例,经产妇22例。有1次剖宫产史者9例。有剖宫产指征59例,无剖宫产指征15例。手术麻醉除2例为局麻,其余均为连续硬膜外麻醉。均为子宫下段剖宫产术。妊娠合并子宫肌瘤行肌瘤剜除术4例。

    1.3 诊断标准:胎儿娩出后24h内阴道出血 500ml者称为产后出血。产时及产后24h内出血量1000ml者为严重产后出血。采用容积法和目测法相结合测定产后出血。

    1.4 统计学处理:采用术中和检验进行比较。

    2 结果

    2.1 剖宫产术中出血与同期平产,阴道助产产出血量的比较(见表1)。

    我院5年内平产后出血率为4.5 4% (80/1759),剖宫产产后出血率4.38% (74/1689)两者相比无明显差异,但表1示在各组出血量上两者有显著性差异,P值均, http://www.100md.com(罗 平)
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