不同休克程度产后出血患者DSA影像表现与临床治疗效果比较分析

摘要

目的探讨不同休克程度产后出血患者DSA影像特点，比较分析不同治疗方法的临床治疗效果，为临床医师选择合适的治疗方法提供参考依据。方法收集整理我院治疗产后出血132例患者的临床资料进行休克程度分度，依据不同治疗方法分组，采用产科治疗的患者称为产科组，采用介入治疗的患者称为介入组。比较两组患者不同休克程度产后出血治疗的休克纠正时间、补血量、补液量、子宫保有率及康复时间有无统计学意义；比较不同休克程度DSA表现。结果轻度休克的患者共61例，产科组37例，采取保守治疗，介入组24例，采取介入治疗，两组均无子宫切除，两组患者休克纠正时间、康复时间比较有统计学意义，补血量、补液量、子宫保有率比较无统计学意义，DSA图像可见子宫染色较浓；中度休克的患者共40例，产科组19例，其中采用双侧子宫动脉/髂内动脉结扎术18例，子宫全切术1例，介入组21例，采取介入治疗，无子宫切除。两组患者休克纠正时间、补血量、补液量、康复时间比较有统计学意义，子宫保有率比较无统计学意义，DSA图像可见子宫局部呈“小点”状或“小片”状对比剂外溢及积聚征象；重度休克的患者共31例，产科组13例，其中采用双侧子宫动脉/髂内动脉结扎术8例，子宫全切术5例，介入组18例，采取介入治疗，术后1例行子宫全切术，DSA图像可见“片”状、“大片”状或“团”状对比剂外溢或积聚。结论不同休克程度产后出血患者DSA影像表现不同，揭示出血情况不同；轻度休克的患者产科治疗、介入治疗均可选择，治疗效果均佳；中度休克的患者产科治疗、介入治疗均可选择,介入治疗的效果优于产科治疗；重度休克的患者应首选介入治疗，介入治疗的效果明显优于产科治疗；产后出血的治疗应根据不同的医疗条件、不同的休克程度选择合理的治疗方法。%ObjectiveTo compare the digital subtraction angiography(DSA) features with effects of treatment in patients with postpartum hemorrhagic shock.Methods 132 patients with mild(61), moderate(40) or severe(31) postpartum hemorrhagic shock received obstetrical or interventional treatment. The DSA features, time of shock correction, volume of blood or fluid replacement, retention rate of uterus and recovery time were statistically compared between the two types of treatment.Results 61 patients with mild degree of shock underwent conservative treatment(37) or interventional therapy(24). No hysterectomy was required in any patient. The time of shock correction and recovery time was significantly different between the two groups(P<0.05) whereas the volume of blood or fluid replacement and retention rate of uterus was not significantly different(P>0.05). Typical hemorrhage signs were seldom observed on DSA. Deeply-stained uterus was seen in most patients. Of 40 patients with moderate shock, 18 underwent bilateral uterine artery or internal iliac artery ligation, 1 required total hysterectomy, 21 underwent interventional therapy. The time of shock correction, volume of blood or fluid replacement, and recovery time differed significantly(P<0.05) whereas the rate of uterus retention was not significantly different(P>0.05) between the two groups. DSA showed punctate contrast extravasation. Of 31 patients with severe shock, 8 underwent bilateral uterine artery or internal iliac artery ligation, 5 required total hysterectomy, and 18 received interventional therapy. One patient required total hysterectomy after interventional treatment. DSA showed puddling of the extravasated contrast.Conclusion Patients with postpartum hemorrhagic shock of varying degrees show different DSA features. Both conservative and interventional treatments are suitable for patients with mild to moderate degree of shock whereas interventional therapy is significantly better in severe shock.