摘要
目的 观察剖宫产产后出血治疗中宫腔内一次性宫腔压迫球囊套件填塞与子宫动脉上行支结扎术联用疗效.方法 回顾性选取2020年1月至2023年9月入滁州市第一人民医院的76例剖宫产产后出血患者,参考不同治疗方式分为研究组(n=38)与对照组(n=38).研究组行宫腔内一次性宫腔压迫球囊套件填塞联合子宫动脉上行支结扎术,对照组单行球囊套件填塞术.比较两组患者手术前后血栓弹力图指标[血块形成点到描记图最大曲线弧度切线和水平线之间夹角(AngLe角)、凝血时间(K)、最大振幅(MA)、反应时间(R)]与围术期指标(术中出血量、术后1 d出血量、输血量、手术时间、止血时间、切口恢复正常时间、下床时间、住院时间及月经恢复正常时间)、止血有效率及并发症(产后发热、宫腔黏连、子宫复旧不良)发生率.结果 与术前比较,两组患者术后的AngLe角、MA、R均显著更高,K均显著更低,差异均有统计学意义(P＜0.05);研究组患者术后AngLe角、MA、R分别为(76.23±6.94)°、(68.23±6.91)mm、(6.63±0.68)min,均显著高于对照组[(71.38±6.75)°、(62.04±6.58)mm、(5.92±0.63)min],差异均有统计学意义(P＜0.05).研究组患者术中出血量、术后1 d出血量、输血量分别为(913.85±56.17)、(162.84±59.83)、(469.61±90.67)mL,均显著低于对照组[(1 263.47±101.86)、(224.72±60.36)、(640.08±99.85)mL],研究组患者手术时间为(80.73±4.71)min,显著长于对照组[(67.25±5.29)min],研究组患者止血时间、切口恢复正常时间、下床时间、月经恢复正常时间及住院时间分别为(13.02±2.08)min、(6.47±1.29)d、(3.09±0.38)d、(11.31±2.17)d、(3.47±0.28)个月,均显著短于对照组[(18.81±1.97)min、(8.91±1.08)d、(4.62±0.58)d、(14.25±2.09)d、(5.89±0.19)个月],差异均有统计学意义(P＜0.05).研究组患者的止血有效率为97.37％,显著高于对照组(78.95％),差异有统计学意义(P＜0.05).研究组患者的总并发症发生率为5.26％,显著低于对照组(23.68％),差异有统计学意义(P＜0.05).结论 剖宫产产后出血治疗中宫腔内一次性宫腔压迫球囊套件填塞与子宫动脉上行支结扎术联用疗效显著,可显著改善患者凝血功能,增强止血效果,降低出血量,还可促使其快速康复,并发症少.
Abstract
Objective To study the effect of intrauterine one-time balloon compression kit tamponade combined with ascending branch ligation of uterine artery on postpartum hemorrhage after cesarean section.Methods A total of 76 patients with postpartum hemorrhage after cesar-ean section admitted to Chuzhou First People's Hospital from January 2020 to September 2023 were retrospectively observed.They were divided into the study group(n=38)and the control group(n=38)according to the different treatment methods.In the study group,disposable intrauter-ine pressure balloon kit tampon combined with ligation of the superior uterine artery were performed.The control group was treated with intrauterine disposable intrauterine compression balloon kit.The thromboelastography indexes[AngLe between the point of clot formation and the maximum curve curve tangent and horizontal line of the graph,coagulation time(K),maximum amplitude(MA),reaction time(R)]before and after sur-gery,and perioperative indexes(intraoperative bleeding volume,postoperative 1-day bleeding volume,blood transfusion volume,surgical time,hemostasis time,incision recovery time,time to get out of bed,hospitalization time,and menstrual recovery time),hemostasis efficiency and inci-dence of complications(postpartum fever,uterine adhesion,poor uterine involvment)were compared between the two groups.Results After sur-gery,the AngLe angle,MA,and R of the two groups of patients were significantly higher than those before surgery,while K were significantly low-er than those before surgery,the AngLe angle,MA,and R of the study group patients were(76.23±6.94)°,(68.23±6.91)mm,and(6.63±0.68)min,respectively,which were significantly higher than those of the control group[(71.38±6.75)°,(62.04±6.58)mm,and(5.92±0.63)min],and the differences were statistically significant(P＜0.05).The intraoperative bleeding volume,postoperative 1-day bleeding volume,and blood transfusion volume of the study group patients were(913.85±56.17),(162.84±59.83),and(469.61±90.67)mL,re-spectively,which were significantly lower than those of the control group[(1 263.47±101.86),(224.72±60.36),(640.08±99.85)mL],the surgical time of the study group patients was(80.73±4.71)min,which was significantly longer than that of the control group[(67.25±5.29)min],the hemostasis time,incision recovery time,bed removal time,menstrual recovery time,and hospital stay time of the study group patients were(13.02±2.08)min,(6.47±1.29)d,(3.09±0.38)d,(11.31±2.17)d,and(3.47±0.28)months,which were significantly shorter than those of the control group[(18.81±1.97)min,(8.91±1.08)d,(4.62±0.58)d,(14.25±2.09)d,and(5.89±0.19)months],and the differences were statistically significant(P＜0.05).The effective rate of hemostasis in the study group was 97.37％,which was higher than that in the control group(78.95％),and the difference was statistically significant(P＜0.05).The total incidence of complica-tions in the study group was 5.26％,which was significantly lower than that in the control group(23.68％),and the difference was statistically significant(P＜0.05).Conclusion Intrauterine one-time intrauterine compression balloon kit combined with ascending branch ligation of u-terine artery is effective in the treatment of postpartum hemorrhage after cesarean section,which can significantly improve the coagulation function of patients,enhance the hemostatic effect and reduce the amount of blood loss,and also promote their rapid recovery with fewer complications.
基金项目
安徽省卫生健康委科研项目(2021)(AHWJ2021b005)
维普
万方数据