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目的:探讨不同分娩方式产后出血患者行急症子宫切除术的临床指征。方法:患者按照分娩方式分为阴道分娩组16例和剖宫产组38例,分别记录各患者子宫切除的临床指征,包括前置胎盘、胎盘早剥、胎盘植入、宫缩乏力、子宫破裂、子宫感染等,并对患者及胎儿的死亡情况进行比较。结果:行急症子宫切除术患者中,剖宫产组例数明显高于阴道分娩组(38vs16),差异具有显著性(P<0.05);在所有患者中,宫缩乏力(35.19%)、子宫破裂(25.93%)、胎盘植入(20.37%)是主要的手术指征,剖宫产组患者死亡率(2.63%)和胎儿死亡率(18.42%)均明显高于对照组,数据经统计学比较,具有显著差异(P<0.05)。结论:宫缩乏力、子宫破裂、胎盘植入和剖宫产是产科产后出血行急症子宫切除术的主要临床指征,医疗工作者应注意患者的病史询问、病症检查,根据指征提示选择好手术时机,尽可能提高临床生存率。
Objective: To investigate the clinical indications of emergency hysterectomy in different modes of delivery postpartum hemorrhage. Methods: According to the mode of delivery, the patients were divided into vaginal delivery group (n = 16) and cesarean section group (n = 38). The clinical indications of hysterectomy were recorded, including placenta previa, placental abruption, placenta accreta, Rupture, uterine infection, etc., and compare patient and fetal deaths. Results: Among the patients who underwent emergency hysterectomy, the number of cesarean section group was significantly higher than that of vaginal delivery group (38 vs. 16) (P <0.05); in all the patients, uterine inertia (35.19%), Rupture (25.93%) and placenta accreta (20.37%) were the main surgical indications. The mortality rate in cesarean section group (2.63%) and fetal mortality rate (18.42%) were significantly higher than those in control group Compared with significant differences (P <0.05). Conclusions: Uterine atony, uterine rupture, placenta accreta and cesarean section are the main clinical indications of emergency hysterectomy for obstetric postpartum hemorrhage. Medical workers should pay attention to the patient’s medical history, check the condition, and choose according to the indications The timing of surgery, as much as possible to improve the clinical survival rate.