摘要
目的探讨难治性产后出血发生严重凝血功能障碍时介入栓塞治疗的可能性及成功率。方法选择天津市第三中心医院2015年1月至2022年2月收治的难治性产后出血介入栓塞治疗的38例病例,按患者的凝血功能指标将其分为弥散性血管内凝血(DIC)组(14例)和非DIC组(24例),比较两组的凝血功能指标、出血量、血红蛋白、DIC的Takao评分和首次介入栓塞治疗失败率。结果造成38例患者产后出血的原因有:宫缩乏力18例,羊水栓塞3例,胎盘早剥3例,剖宫产后盆腔血肿3例,前置胎盘2例,胎盘植入2例(其中1例为胎盘植入残留宫腔),双胎妊娠2例,产褥期感染2例,急性脂肪肝1例,产褥期子宫动静脉瘘1例,剖宫产术后阴道分娩(VBAC)子宫破裂1例。其中3例患者因子宫切除后仍有出血而实施的介入下栓塞治疗。与非DIC组相比,DIC组介入治疗前凝血功能更差,出血量更多(mL:2878.57±1115.75比1657.08±1027.25)、血红蛋白更低(g/L:68.00±28.46比88.96±23.65),DIC评分更高(分:11.57±3.80比3.25±2.54),差异均有统计学意义(均P<0.05)。两组都成功实施介入栓塞治疗止血,首次失败率DIC组高于非DIC组〔28.57%(4/14)比8.33%(2/24)〕,差异有统计学意义(P<0.05),两组再次行介入栓塞治疗成功率均达100%。结论介入栓塞治疗在难治性产后出血发生严重凝血功能障碍时应用也十分成功。
Objective To discuss the possibility and success rate of interventional embolization in refractory postpartum hemorrhage with severe coagulation dysfunction.Methods A total of 38 patients with refractory postpartum hemorrhage admitted to Tianjin Third Central Hospital from January 2015 to February 2022 were selected for interventional embolization and divided into disseminated intravascular coagulation(DIC)group(14 cases)and non-DIC group(24 cases)according to their coagulation function indexes.And the coagulation function indexes,blood loss,hemoglobin,Takao score of DIC,and the failure rate of first interventional embolization were compared between the two groups.Results The causes of postpartum hemorrhage in 38 patients were as follows:18 cases of uterine fatigue,3 cases of amniotic fluid embolism,3 cases of placental abruption,3 cases of pelvic hematoma after cesarean section,2 cases of placenta previa,2 cases of placenta accretion(including 1 case of residual placenta accretion in uterus),2 cases of twin pregnancy,2 cases of puerperal infection,1 case of acute fatty liver,1 case of uterine arteriovenous fistula during puerperal period,and 1 case of uterine rupture after vaginal birth after cesarean(VBAC).Interventional embolization was performed in 3 patients with bleeding after hysterectomy.Compared with the non-DIC group,coagulation function was worse in the DIC group before treatment,blood loss was more(mL:2878.57±1115.75 vs.1657.08±1027.25),hemoglobin was lower(g/L:68.00±28.46 vs.88.96±23.65),and DIC score was higher(score:11.57±3.80 vs.3.25±2.54),the differences were statistically significant(all P<0.05).The first failure rate in the DIC group was higher than that in the non-DIC group[28.57%(4/14)vs.8.33%(2/24)],the difference was statistically significant(P<0.05),and the success rate of the second interventional embolization was 100%in both groups.Conclusion Interventional embolization is also very successful in severe coagulation dysfunction caused by refractory postpartum hemorrhage.
作者
马春蕾
梁茜
Ma Chunlei;Liang Qian(Department of Obstetrics,Tianjin Third Central Hospital,Tianjin 300170,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2023年第1期87-89,共3页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
关键词
难治性产后出血
介入栓塞治疗
弥漫性血管内凝血功能障碍
Refractory postpartum hemorrhage
Interventional embolization therapy
Disseminated intravascular coagulation
