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目的:探讨治疗难治性产后出血实施改良B-Lynch缝合术的时机选择,并通过评价其安全性,为临床上推广此项技术特别是在基层医院运用此项技术有效治疗难治性产后出血提供依据。方法:本研究选择2012年3月至2015年7月于本院行剖宫产手术,术中发生产后出血达800ml以上,出血原因包括子宫收缩乏力性、前置胎盘等原因,经按摩子宫、药物加强宫缩、局部缝扎止血等处理无效行改良B-Lynch缝合术的产妇。分为A组:产后出血量达800 ml行改良B-Lynch缝合术者;B组:产后出血量达1200 ml行改良B-Lynch缝合术者;C组:产后出血达1200 ml未行改良B-Lynch缝合术者。评估患者出血量、子宫切除率、子宫复旧及其功能恢复情况、术后并发症发生率等,评价改良B-Lynch缝合术手术时机的选择及其安全性。结果:三组患者出血量有显著性差异(P<0.01);A组患者无一例需行子宫切除,未发生其它并发症。结论:在剖宫产术中发生产后出血,及时行B-Lynch缝合术可以明显减少产后出血量,产后出血量达800 ml行改良B-Lynch缝合术者,对难治性宫缩乏力性产后出血效果显著,值得推广。
OBJECTIVE: To explore the timing of improved B-Lynch suture in the treatment of refractory postpartum hemorrhage and to evaluate the safety of this technique for the clinical promotion of this technique, especially in primary hospitals, to effectively treat refractory postpartum hemorrhage Provide evidence. Methods: This study selected March 2012 to July 2015 in our hospital cesarean section surgery, intraoperative bleeding occurred after more than 800ml, causes of bleeding, including uterine atony, placenta previa and other reasons, the massage the uterus, Drugs to strengthen contractions, local suture hemostasis and other treatments ineffective line improved B-Lynch suture maternal. Were divided into group A: postpartum hemorrhage amount of 800 ml improved B-Lynch suture; B group: postpartum hemorrhage amount 1200 ml improved B-Lynch suture; C group: postpartum hemorrhage up to 1200 ml did not improve B -Lynch suture. Evaluate the patient’s bleeding, hysterectomy, uterine involution and functional recovery, the incidence of postoperative complications, etc. to evaluate the timing and safety of modified B-Lynch suture surgery. Results: There was a significant difference in the amount of bleeding between the three groups (P <0.01). None of the patients in group A had hysterectomy and no other complications occurred. Conclusion: Postpartum hemorrhage occurs in cesarean section and timely B-Lynch suture can significantly reduce the amount of postpartum hemorrhage. The amount of postpartum hemorrhage is 800 ml in patients with improved B-Lynch suture. Bleeding effect is significant, it is worth promoting.