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目的:分析在产后大出血抢救中产科急症子宫切除术的应用效果与有关因素。方法:2008年3月~2015年3月期间共16800例产妇于我院分娩,其中11例行急症子宫切除术,回顾性分析其年龄、孕周、产次、分娩方式等一般资料,分析手术指征与影响因素。结果:11例患者中共1例行全子宫切除术,10例行次全子宫切除术;术中出血量平均(3650±30)ml,手术时间平均(109.5±13.4)min。术后所有患者均治愈出院,住院时间平均(10.2±0.6)d;经产妇的急症子宫切除术率为0.11%(4/3600),大于初产妇0.053%(7/13200),P<0.05,差异显著;产妇产后大出血后行急症子宫切除术的手术指征依次为胎盘因素、宫缩乏力、子宫破裂与凝血功能障碍。结论:产科急症子宫切除术的危险因素主要是胎盘因素,临床上必须对可能发生的胎盘异常种植进行积极预防,尤其是对经产妇、行剖宫产等高危产妇,能够使子宫切除率显著降低。
Objective: To analyze the effect and related factors of obstetric emergency hysterectomy in postpartum hemorrhage rescue. Methods: Between March 2008 and March 2015, a total of 16,800 women were delivered in our hospital. Eleven patients underwent emergency hysterectomy. General data such as age, gestational age, delivery time and mode of delivery were analyzed retrospectively. Indications and influencing factors. Results: Of the 11 patients, 1 received hysterectomy and 10 received subtotal hysterectomy. The average amount of bleeding during operation was (3650 ± 30) ml and the average operation time was (109.5 ± 13.4) min. All patients were cured and discharged after hospitalization (10.2 ± 0.6 days), the rate of emergency hysterectomy was 0.11% (4/3600), 0.053% (7/13200), P <0.05, Significant difference; maternal postpartum hemorrhage emergency hysterectomy surgical indications followed by placental factors, uterine atony, uterine rupture and coagulation disorders. Conclusion: The main risk factors of obstetric emergent hysterectomy are placental factors. Proper precautions should be taken to prevent placental malformations. In particular, high-risk maternal women who undergo cesarean section can significantly reduce the rate of hysterectomy .