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目的探讨数字血管减影血管造影(DSA)辅助下血管栓塞介入治疗产后出血(PHH)的临床效果。方法选择2014年1月-2016年2月因PHH经保守治疗无效而在该院接受血管栓塞介入治疗的42例产妇为研究对象,通过DSA明确动脉出血部位,使用栓塞剂对参与供血血管栓塞止血。观察记录患者治疗前后的血管造影表现、临床疗效、血压(BP)、心率(HR)、血红蛋白(Hb)水平、术后不良反应等指标并作分析比较。结果 42例患者子宫动脉及其分支存在不同程度增粗、迂曲,少数患者存在造影剂外溢血管湖状外溢或浓聚,1例患者合并髂外动脉分支参与供血,2例合并卵巢动脉参与供血,行靶向血管栓塞治疗后均成功止血;栓塞治疗后立即停止出血30例,出血显著减少12例且经相应对症处理后出血停止,无子宫切除患者,止血成功率与技术成功率均为100%;栓塞治疗后,较治疗前心率(HR)明显降低恢复稳定,收缩压(SBP)与舒张压(DBP)均逐步上升并维持正常,血红蛋白(Hb)水平明显增高,差异具有统计学意义(t=4.094、4.012、3.136、4.310,P<0.05);术后不良反应方面,发热16例,3例患者出现轻度的下腹部、臀部及下肢疼痛等不良反应,给予症治疗3~6 d内均好转,未发现其他严重并发症。结论针对PHH患者,采用DSA辅助的血管栓塞治疗疗效显著,成功率与止血率较高,止血准确迅速,不良反应少,且相对于传统方法能最大限度地保留患者的生育功能,值得推广。
Objective To investigate the clinical effect of interventional treatment of postpartum hemorrhage (PHH) assisted by digital angiographic subtraction angiography (DSA). Methods From January 2014 to February 2016, 42 maternal women receiving PHT in our hospital due to ineffective conservative treatment of PHH were enrolled in this study. DSA was used to identify the site of arterial bleeding and the use of embolic agent to stop bleeding . The angiographic performance, clinical efficacy, blood pressure (BP), heart rate (HR), hemoglobin (Hb) level and postoperative adverse reactions were recorded and analyzed before and after treatment. Results In 42 patients, the uterine artery and its branches were enlarged and tortuated to a certain degree. In a few patients, there was lacustrine spillover or agglomeration of contrast agent spillover vessels. One patient was involved in supplying blood with branch of external iliac artery and two patients with ovarian artery involved in blood supply. 30 cases of hemorrhage stopped immediately after embolization treatment, bleeding was significantly reduced by 12 cases and stopped by the corresponding symptomatic treatment bleeding, without hysterectomy, the success rate of hemostasis and technical success rates were 100% ; After embolization, the heart rate (HR) decreased significantly, the SBP and DBP increased gradually and remained normal, the hemoglobin (Hb) level increased significantly, the difference was statistically significant (t = 4.094,4.012,3.136,4.310, P <0.05); adverse reactions, 16 cases of fever, 3 patients showed mild lower abdominal, buttocks and lower extremity pain and other adverse reactions, to give symptomatic treatment within 3 ~ 6 d All improved, did not find other serious complications. Conclusions For patients with PHH, the DSA-assisted embolization has a significant effect, with high success rate and hemostasis rate, rapid and accurate hemostasis, and few side effects. Compared with the traditional methods, maximally retained reproductive function of patients is worthy of promotion.