摘要
目的比较双侧子宫动脉上行支结扎与8字缝合法分别联合缩宫素用于前置胎盘剖宫产术中大出血的止血效果。方法回顾性分析2020年3月至2023年7月于上饶市立医院行前置胎盘剖宫产术并于术中发生大出血的72例产妇的临床资料,依据术中止血方式分为结扎组(n=39)与8字缝合组(n=33)。结扎组采用双侧子宫动脉上行支结扎联合缩宫素进行止血处理,8字缝合组采用8字缝合法联合缩宫素进行止血处理。比较两组止血效果、手术情况、术后恢复情况、术后凝血功能指标[纤维蛋白原(fibrinogen,Fg)、凝血酶原时间(prothrombin time,PT)和活化部分凝血活酶时间(activated partial thromboplastin time,APTT)]及术后并发症发生情况。结果结扎组有效止血率为94.87%,高于8字缝合组的75.76%,差异有统计学意义(P<0.05)。结扎组术中出血量、术中输血量均少于8字缝合组,手术时间短于8字缝合组,差异有统计学意义(P<0.05)。结扎组术后1 d阴道出血量少于8字缝合组,差异有统计学意义(P<0.05);两组术后住院时间、产后恶露时间比较差异无统计学意义。术后3 d,两组Fg水平低于术后当天,PT、APTT均短于术后当天,且结扎组Fg水平低于8字缝合组,PT、APTT均短于8字缝合组,差异有统计学意义(P<0.05)。两组产后出血、产褥感染、子宫愈合不良发生率比较差异无统计学意义。结论相较于8字缝合法联合缩宫素止血,双侧子宫动脉上行支结扎联合缩宫素用于前置胎盘破宫产术中大出血中的止血效果更佳,术中及术后的出血量相对更少,且术后发生凝血功能异常的风险较低,不会增加相关并发症发生风险,患者术后生理机能恢复更快。
Objective To compare the hemostatic effect of bilateral ligation of ascending branches of uterine artery and 8-shaped suture combined with oxytocin on massive hemorrhage during cesarean section in placenta previa.Methods The clinical data of 72 puerperae who underwent cesarean section with massive hemorrhage in Shangrao Municipal Hospital from March 2020 to July 2023 were retrospectively analyzed,and they were divided into the ligation group(n=39)and the 8-shaped suture group(n=33)according to different intraoperative hemostasis methods.The ligation group was treated with bilateral ligation of the ascending branches of the uterine artery combined with oxytocin for hemostasis,while the 8-shaped suture group was treated with the 8-shaped suture method combined with oxytocin for hemostasis.The hemostatic effect,surgical situation,postoperative recovery,postoperative coagulation function indexes(fibrinogen[Fg],prothrombin time[PT],activated partial thromboplastin time[APTT])and the occurrence of postoperative complications were compared between the two groups.Results The effective hemostasis rate in the ligation group 94.87%,which was higher than that 75.76%in the 8-shaped suture group,and the difference was statistically significant(P<0.05).The intraoperative blood loss and intraoperative blood transfusion volume in the ligation group were lower than those in the 8-shaped suture group,and operation time was shorter than that in the 8-shaped suture group,the differences were statistically significant(P<0.05).The vaginal bleeding volume at 1 d after surgery in the ligation group was less than that in the 8-shaped suture group,and the difference was statistically significant(P<0.05);there were no significant differences in postoperative length of hospital stay and postpartum lochia time between the two groups.At 3 d after the surgery,the Fg levels of the two groups were lower than that on the day after the operation,PT and APTT were shorter than those on the day after the operation,Fg level in the ligation group was lower than that in the 8-shaped suture group,PT and APTT were shorter than those in the 8-shaped suture group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of postpartum hemorrhage,puerperal infection,poor uterine healing between the two groups.Conclusion Compared with 8-shaped suture combined with oxytocin,the application of bilateral ligation of ascending branches of uterine artery combined with oxytocin has better hemostasis effect in cases of massive hemorrhage during placenta previa and uterine rupture,the amount of bleeding during and after the operation is relatively less,and the risk of abnormal coagulation function after the operation is lower,without increasing the risk of related complications,the physiological functions of patients recover faster after the operation.
作者
徐紫娟
徐小翠
刘晓媛
XU Zijuan;XU Xiaocui;LIU Xiaoyuan(Department of Obstetrics,Shangrao Municipal Hospital,Shangrao,Jiangxi,334000,China)
出处
《当代医学》
2025年第31期36-40,共5页
Contemporary Medicine
关键词
双侧子宫动脉上行支结扎
8字缝合法
缩宫素
前置胎盘
剖宫产术中大出血
止血效果
Bilateral ligation of ascending branches of uterine artery
8-shaped suture
Oxytocin
Placenta previa
Massive hemorrhage during cesarean section
Hemostatic effect
