摘要
目的探讨产后出血子宫切除术后腹腔内出血的诊断及治疗。方法回顾分析1999年1月至2010年6月广州市重症孕产妇救治中心收治的112例产后出血致围产期子宫切除病例,其中37例为腹腔内出血组,75例为腹腔内未出血组,分析腹腔内出血的诊断、治疗以及术后结局等。结果围产期子宫切除患者中腹腔内出血者37例,发生率为33.0%(37/112);根据引流管引流量直接诊断22例(59.5%),综合监测诊断15例(40.5%);引流管引流量直接诊断腹腔内出血的诊断时间短于综合监测诊断时间(P=0.033)。再次手术治疗17例,非手术治疗20例;死亡11例,其中合并肝功能损害5例,并发羊水栓塞5例。再次手术间隔时间>12h患者总出血量及总输血量均明显高于再次手术间隔时间≤12h者(P=0.008、P=0.015),且呼吸机辅助呼吸时间明显延长(P=0.022)。手术止血3例死亡患者再次手术时间均>12h。结论腹腔内放置引流管有助于早期诊断围产期子宫切除术后腹腔内出血,综合监测评估是判定腹腔内出血的关键。应尽早对短期保守治疗无效或提示残端活动出血者果断手术止血。严重合并症或并发症患者止血同时应强调生命支持。
Objective To analyze the diagnosis and treatment of intra-abdominal bleeding after peripartum hysterectomy in postpartum hemorrhage.Methods A retrospective clinical data was analyzed involving 112cases critically ill obstetric patients performed peripartum hysterectomy for postpartum hemorrhage in Obstetric Critical Care Center of Guangzhou between January 1999 and June 2010,which divided to intra-abdominal bleeding group 37 cases and non-intra-abdominal bleeding group 75 cases depending on whether the patient was underwent intra-abdominal bleeding after peripartum hysterectomy.Main demographic data and clinical details including diagnosis and treatment of intra-abdominal bleeding,and postoperative outcomes were analyzed and compared between two groups.Results Intra-abdominal bleeding was identified in 37 patients（37/112,33.0%） after peripartum hysterectomy.Of these,22（59.5%） cases were diagnosed by elevated bloody output from the drains.Fifteen cases（40.5%） were diagnosed by integrated approaches.The 22 cases took shorter time to diagnose intra-abdominal bleeding by the sanguinous output from the drain in comparison to the comprehensive approaches（P=0.033）.Of the 37 patients treated,17 patients were re-explored,and the others were treated non-operatively.There were 11 cases maternal deaths,including 5 complicated with hepatic failure and 5 complicated with amniotic fluid embolism.The group of patients who were re-explored 12 h in comparison to≤12 h group had more total blood loss,total blood transfusion（P=0.008;P=0.015）,longer duration of mechanical ventilation（P=0.022）.There were 3 cases maternal deaths in re-explored 12 h group.Conclusions An integrated monitoring is critical measures of determinant of intra-abdominal bleeding after peripartum hysterectomy,in spite of drains allowed early diagnosis of intra-abdominal bleeding.It is necessary to perform surgical hemostasis without hesitation when short time conservative treatment is ineffective or stump vascular activity bleeding is indicated;It is necessary to emphasize vital support when patients with severe complications are stopped the hemorrhage.
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2012年第11期830-834,共5页
Chinese Journal of Practical Gynecology and Obstetrics
基金
广州市教育局科研基金(61060)
广东省卫生厅科研基金(A2005558)
