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目的探讨产后出血子宫切除术后腹腔内出血的诊断及治疗。方法回顾分析1999年1月至2010年6月广州市重症孕产妇救治中心收治的112例产后出血致围产期子宫切除病例,其中37例为腹腔内出血组,75例为腹腔内未出血组,分析腹腔内出血的诊断、治疗以及术后结局等。结果围产期子宫切除患者中腹腔内出血者37例,发生率为33.0%(37/112);根据引流管引流量直接诊断22例(59.5%),综合监测诊断15例(40.5%);引流管引流量直接诊断腹腔内出血的诊断时间短于综合监测诊断时间(P=0.033)。再次手术治疗17例,非手术治疗20例;死亡11例,其中合并肝功能损害5例,并发羊水栓塞5例。再次手术间隔时间>12h患者总出血量及总输血量均明显高于再次手术间隔时间≤12h者(P=0.008、P=0.015),且呼吸机辅助呼吸时间明显延长(P=0.022)。手术止血3例死亡患者再次手术时间均>12h。结论腹腔内放置引流管有助于早期诊断围产期子宫切除术后腹腔内出血,综合监测评估是判定腹腔内出血的关键。应尽早对短期保守治疗无效或提示残端活动出血者果断手术止血。严重合并症或并发症患者止血同时应强调生命支持。
Objective To investigate the diagnosis and treatment of intraperitoneal hemorrhage after postpartum hemorrhage hysterectomy. Methods The cases of perinatal hysterectomy in 112 cases of postpartum hemorrhage admitted to Guangzhou Severe Maternal and Child Health Center from January 1999 to June 2010 were retrospectively analyzed. Among them, 37 cases were intraperitoneal hemorrhage group, 75 cases were intraperitoneal non-hemorrhage group, Analysis of intra-abdominal bleeding diagnosis, treatment and postoperative outcomes. Results The incidence of intraperitoneal hemorrhage was 37.0% (37/112) in peritoneal hysterectomy patients, 22 cases (59.5%) were directly diagnosed according to drainage of drainage tube, 15 cases (40.5%) were diagnosed by comprehensive monitoring, and drainage The diagnosis of intra-abdominal hemorrhage with direct drainage of the duct was shorter than that of the integrated monitoring (P = 0.033). Reoperation 17 cases, 20 cases of non-surgical treatment; 11 cases of death, including 5 cases of hepatic impairment, complicated by amniotic fluid embolism in 5 cases. Total rebleeding volume and total blood transfusion volume were significantly higher in reoperation interval> 12h than those in reoperation ≤12h (P = 0.008, P = 0.015), and ventilator assisted breathing time was significantly prolonged (P = 0.022). Three patients died of surgery to re-operation time were> 12h. Conclusion Intraperitoneal placement of drainage tube is helpful for the early diagnosis of intraperitoneal hemorrhage after perinatal hysterectomy. Comprehensive monitoring and evaluation is the key to determine intra-abdominal hemorrhage. Should be as soon as possible conservative treatment of short-term invalid or prompt stump bleeding activity decisive surgery to stop bleeding. Serious complications or complications of hemostasis should also emphasize life support.