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目的探讨在难治性前置胎盘产后出血(PPH)的治疗中采用卡前列素氨丁三醇联合低位B-Lynch缝合术的临床疗效及安全性。方法采用回顾性研究方法,将2011年5月至2015年5月收治的108例难治性前置胎盘性PPH患者按照治疗方法分为对照组(n=53)与观察组(n=55)。两组均行剖宫产分娩。对照组给予缩宫素,并于胎盘剥离面行“8”字间断缝合术;观察组则采用卡前列素氨丁三醇联合低位B-Lynch缝合术。比较两组临床疗效、术中出血量、术后2 h阴道出血量及术后24 h阴道出血量、不良反应发生率。两组患者若止血无效,则给予导管动脉栓塞(TAE)术止血;若TAE术仍不能明显止血,则行子宫切除。结果 (1)经治疗,观察组显效、有效及无效例数分别为34例、19例及2例,临床总有效率为96.36%(53/55);对照组显效、有效及无效例数分别为15例、24例及14例,临床总有效率为73.58%(39/53)。两组疗效差异具有统计学意义(P<0.05)。(2)两组术中出血量差异无统计学意义(P>0.05),但观察组患者术后2 h及24 h阴道出血量均明显小于对照组(P均<0.01)。(3)对照组患者治疗后不良反应发生率为22.64%(12/53),观察组为7.27%(4/55),两组不良反应发生率差异具有统计学意义(P<0.01)。结论卡前列素氨丁三醇联合低位B-Lynch缝合术治疗难治性前置胎盘产后出血,临床疗效显著,术后不良反应发生率低。
Objective To investigate the clinical efficacy and safety of carboprost trometamol combined with low-level B-Lynch suture in the treatment of refractory placenta previa (PPH). Methods A retrospective study was conducted on 108 patients with refractory placenta previa (PPH) who were treated from May 2011 to May 2015. The patients were divided into control group (n = 53) and observation group (n = 55) . Cesarean delivery was performed in both groups. Oxytocin was administered to the control group, and interrupted sutures were performed on the placental detachment surface. The observation group was treated with carboprost trometamol combined with low-grade B-Lynch suture. The clinical curative effect, intraoperative blood loss, vaginal bleeding volume at 2 h postoperatively, vaginal bleeding volume at 24 h postoperatively and the incidence of adverse reactions were compared between the two groups. If the hemostasis was not effective in both groups, TAE was given to stop the bleeding. If the TAE still failed to stop bleeding, hysterectomy was performed. Results (1) After treatment, the number of effective, effective and ineffective cases in observation group were 34 cases, 19 cases and 2 cases, respectively. The total effective rate was 96.36% (53/55) in the observation group. The effective, 15 cases, 24 cases and 14 cases, the total clinical effective rate was 73.58% (39/53). The difference between the two groups was statistically significant (P <0.05). (2) There was no significant difference in the amount of blood loss between the two groups (P> 0.05). However, the volume of vaginal bleeding at 2 h and 24 h after operation in the observation group was significantly lower than that in the control group (all P <0.01). (3) The incidence of adverse reactions was 22.64% (12/53) in the control group and 7.27% (4/55) in the observation group. There was significant difference in the incidence of adverse reactions between the two groups (P <0.01). Conclusion The combination of carboprost trometamol and low-grade B-Lynch suture in the treatment of postpartum hemorrhage in refractory placenta previa has significant clinical effect and low postoperative adverse reaction rate.