剖宫产术中应用子宫按摩后行胎盘剥离减少术中失血的临床研究

摘要

Objective:Discussion on cesarean section uterine massage again first placenta on effects of intraoperative blood loss. Methods:Randomly controlled clinical trial was adopted which contained 120 cases. The observation group(n=60) were performed immediate uterine massage after the delivery of the baby,combining with oxytocin 10 U intramuscular injection on the uterine fund us,and then other kinds of operation such as placenta separation,saturation of the uterus incision were performed when the excellent uterine contraction was got. The control group(n=60),after the baby delivery,intramuscular injection of oxytocin 10 U,were immediately performed immediate manual removal of the placenta,and then the procedure for hemostasis and saturation of the uterus incision. To record the blood loss from the baby delivery to the end of closing up the uterine incision and the time cost in the procedure,to count the ratio which needed extra technique for hemostasis. Compared between the two groups from the fetus to the percentage of the uterine suture required time and the period of time the amount of bleeding and the need for additional hemostatic operation.Results:The operation time in the observation group was longer than the control group,but there was no significant difference statistically (P>0.05);The difference of blood loss was statically significant (P<0.05),observation group’s was less;The percentage of extra hemostasis in the observation group was less than in the control group (P<0.05).Conclusion:It is benefit for decreasing the blood loss and extra hemostasis and without increasing the operation time at caesarean section by the procedure of uterine massage after baby delivery and latter placenta delivery when getting good uterus contraction.%　　目的：探讨剖宫产术中先行子宫按摩再剥离胎盘对术中失血量的影响.方法：采用随机对照试验,分析120例剖宫产术患者.观察组60例,于胎儿娩出后行子宫按摩,同时子宫肌内注射缩宫素10 U,待子宫收缩良好后再行胎盘剥离、缝合等操作；对照组60例,于胎儿娩出后子宫肌内注射缩宫素10 U,然后立即行手工剥离胎盘、止血、缝合等操作.比较两组自胎儿娩出至子宫缝合所需时间及该时间段内出血量以及需要额外止血操作的百分比.结果：观察组较对照组在手术时间上稍延长,但差异无统计学意义(P>0.05)；观察组较对照组平均出血量减少,差异有统计学意义(P<0.05)；观察组较对照组需行额外止血操作的比例减少,差异有统计学意义(P<0.05).结论：剖宫产术中于胎儿娩出后先行子宫按摩,待子宫良好收缩后再行胎盘剥离在不延长手术时间的前提下有助于减少术中失血,并可以简化止血操作.