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目的探讨剖宫产术中出血的原因及防治措施。方法选择本院2007年6月至2008年10月住院剖宫产患者567例,其中术中出血≥500 ml者9例,对其临床资料进行回顾性总结分析。结果本组9例中宫缩乏力5例,前置胎盘1例;胎盘早剥1例;胎盘植入1例,胎盘部位滋养细胞肿瘤1例。其中7例患者经适当加大宫缩剂剂量,热盐水纱垫按摩子宫,在活动性出血部位8字缝扎,宫腔填塞宫纱等处理后活动性出血停止;2例经上述处理无效,行子宫动脉上支结扎术后出血停止。其中7例患者经适当加大宫缩剂剂量,热盐水纱垫按摩子宫,快速补足血容量,在活动性出血部位8字缝扎,宫腔填塞宫纱等处理后活动性出血停止;2例经上述处理无效,行子宫动脉上支结扎术后出血停止。结论剖宫产术中出血的原因包括宫缩乏力性出血、胎盘因素导致的出血、羊水栓塞、胎盘部位滋养细胞肿瘤等,对于术中出血的处理,必须迅速明确出血原因,针对不同的病因给予相应的防治措施,对迅速止血和降低剖宫产术中出血的发生率有重要意义。
Objective To investigate the causes of bleeding during cesarean section and its prevention and treatment. Methods 567 hospitalized patients with cesarean section were selected from June 2007 to October 2008 in our hospital, of which 9 cases had intraoperative blood loss≥500 ml, and their clinical data were retrospectively analyzed. Results The group of 9 cases of uterine inertia in 5 cases, 1 case of placenta previa, 1 case of placental abruption, 1 case of placenta accreta, 1 case of placental trophoblastic tumor. 7 cases of patients with appropriate dose of uterotonics, hot salt water mats massage the uterus, active bleeding in the site of 8 suture, intrauterine stuffing palace gauze and other active bleeding stopped; 2 cases by the above treatment is invalid, Uterine artery ligation after bleeding stopped. Among them, 7 patients were treated with uterine massage by heating the uterus to increase the volume of the uterotrophic system, 8-suture in the active bleeding site, intrauterine stuffing of the uterus, etc. The active bleed stopped after 2 treatments After the above treatment is invalid, the line of uterine artery ligation stopped bleeding. Conclusions The causes of bleeding in cesarean section include uterine bleeding, placental bleeding, amniotic fluid embolism, and placental trophoblastic tumor. For the treatment of intraoperative bleeding, the cause of bleeding must be promptly defined and given for different causes The corresponding prevention and treatment measures are of great significance to the rapid hemostasis and reduce the incidence of bleeding in cesarean section.