剖宫产胎盘期待剥离预防产后出血的临床研究(1)
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[摘要] 目的：观察剖宫产术中胎盘期待剥离对产后出血的效果。方法：选择100例剖宫产患者，将其随机分成两组，各50例，术中胎儿娩出后，立即剥离胎盘为对照组，期待子宫收缩后剥离胎盘为观察组。观察两组术中、产后24 h出血量、手术时间及观察组期待时间。结果：观察组术中及产后24 h的出血量显著少于对照组(P<0.01)，两组手术时间比较，无显著性差异(P>0.05)。结论：胎盘期待剥离通过增强“生理性子宫缝合”功能，有效地减少了剖宫产术中和产后24 h出血，但不延长手术时间。
[关键词] 胎盘期待剥离；剖宫产；产后出血
[中图分类号] R714.461[文献标识码]A [文章编号]1673-7210(2010)10(c)-034-03
Clinical study on placental expectant separation to prevent the pastpartum hemorrhage in the cesarean delivery
LI Hong1, XU Huiying1, JIAO Cunxian2
(1.Department of Gynaecology and Obstetrics, Yunnan Women and Child Hospital, Kunming 650224, China; 2.Department of Gynaecology and Obstetrics, the First People′s Hospital of Yunnan Province, Kunming 650032, China)
[Abstract] Objective: To evaluate the clinical effect of postpartum hemorrhage by placenta expectant separation during the cesarean delivery. Methods: 100 cases of patients with cesarean delivery were divided equally and randomly into two groups, each 50 cases after the birth of the baby, control group was artificial stripping placentas immediately and in the observation group, the placentas did not be striped until after uterus contraction. The volume of bleeding in the operation and 24 hours after operation, the time of operation, expectant time of study group were observed. Results: The volume of bleeding in the operation and 24 hours after operation were significantly lower in observation group than those of control group (P<0.01). There was no significant difference in the time of operation between two groups (P>0.05). Conclusion: Placenta expectant separation can reduce the bleeding of cesarean delivery effectively by stronger "physiologic sutures" of the uterus. Expectant time do not delay the whole time of operation.
[Key words] Placental expectant separation; Cesarean delivery; Postpartum hemorrhage
近年来，我国剖宫产率呈逐年上升趋势，达40%～50%，最高甚至可达80%以上，随着社会因素和检查技术的提高，不可避免地导致剖宫产率的上升[1-2]。剖宫产创伤较阴道分娩大，出血也相对较多，控制产后出血是提高剖宫产安全性的一个重要环节。为寻找一种安全、有效的方法，我院在剖宫产胎儿娩出后，不急于剥离胎盘，期待其剥离，期待中观察可能引起产后出血的征象，必要时给予相应的治疗，子宫恢复一定程度的收缩后，再娩出胎盘 ......
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