凶险性前置胎盘并发产后大出血患者的子宫切除时机研究

摘要

Objective To study the timing of performing hysterectomy in patients with placenta previa compli-cated with postpartum hemorrhage. Methods Seventy patients of pernicious placenta previa complicated with postpar-tum hemorrhage who underwent hysterectomy in our hospital from Mar. 2013 to Mar. 2015 were selected, including 32 patients receiving hysterectomy immediately after cesarean section (control group) and 38 patients receiving hysterecto-my after failure of conservative treatment (observation group). The bleeding conditions, operation duration and postop-erative conditions of the two groups were compared. Results The amount of bleeding in the observation group was (5 966.5±467.6) ml, significantly higher than (5 432.7±523.8) ml in the control group (P<0.05). The time of getting out of the bed after surgery in the observation group [(3.78±0.97) d] was less than that in the control group [(4.58±1.06) d], but the difference had no statistical significance (P>0.05). The length of hospital stay showed no statistically significant difference between the observation group and the control group [(7.23±3.55) d vs (7.86±2.91) d, P>0.05]. The time of ap-plying antibiotics, the number of patients with complications, and the mortality rate also showed no statistically signifi-cant difference between the two groups (P>0.05). Conclusion For patients of pernicious placenta previa complicated with postpartum hemorrhage, performing hysterectomy after failure of conservative treatment would not increase the ma-ternal risk, compared with immediately after cesarean section.%目的 探讨凶险性前置胎盘并发产后大出血患者的子宫切除时机.方法 选取2013年3月至2015年3月在我院接受治疗的凶险性前置胎盘并发产后大出血后行子宫切除术的患者70例,其中以剖宫产后立即切除子宫的32例作为对照组,38例在进行保守治疗失败后再切除子宫的患者作为观察组.比较两组患者的出血情况、手术时间及术后情况.结果 观察组患者的出血量为(5 966.5±467.6) ml,大于对照组的(5 432.7±523.8) ml,差异有统计学意义(P<0.05);观察组患者术后下床活动时间为(3.78±0.97) d,少于对照组的(4.58±1.06) d,但差异无统计学意义(P>0.05);观察组患者的住院天数[(7.23±3.55) d]与对照组[(7.86±2.91) d]比较差异无统计学意义(P>0.05);观察组患者的抗生素应用时间、发生并发症患者数和病死率分别与对照组比较差异均无统计学意义(P>0.05).结论 凶险性前置胎盘并发产后大出血患者剖宫产后先进行保守治疗,保守治疗失败后再进行子宫切除,不会增加孕产妇的风险.