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目的 探讨产后大出血急诊介入栓塞止血的价值。方法 本组 2 7例产后大出血 ,出血量10 0 0～ 5 0 0 0ml,出血原因为 :中央型前置胎盘 ,宫颈妊娠、产伤、胎盘粘连和滞留 ,宫缩乏力、妊娠高血压综合征 (妊高征 )、凝血功能障碍等 ,多数患者为复合性因素。经临床紧急抢救、输血、抗休克、清宫、使用宫缩剂、止血剂、缝合或 (和 )阴道填塞止血等处理 ,难于控制出血者行急诊介入栓塞止血 ,采用超选择髂内动脉前支插管 ,造影明确诊断后用明胶海绵条或碎片栓塞靶动脉。结果 插管成功率 96 .3% ,发现 1例异位子宫动脉。栓塞后立即止血 2 2例 (81.5 % ) ,渐止血 4例 (14 .81% ) ,总有效率 96 .3%。 8例合并产后DIC ,其中 1例伴有多脏器损伤 ;11例失血性休克均抢救成功。 1例插管未找到子宫动脉 ,而改作子宫切除术。本组无栓塞并发症及病死率。结论 急诊介入栓塞止血是抢救危及生命的产后大出血的理想方法 ,不仅能挽救产妇的生命 ,而且能保留产妇子宫 ,对抢救产后DIC也有良效 ,值得推广应用
Objective To investigate the value of emergency interventional embolization in postpartum hemorrhage. Methods The group of 27 postpartum hemorrhage, bleeding 10 000 ~ 500ml, the bleeding causes are: central placenta previa, cervical pregnancy, birth injury, placental adhesion and retention, uterine atony, pregnancy-induced hypertension syndrome (PIH), coagulopathy, etc. Most patients are complex factors. After clinical emergency rescue, blood transfusion, anti-shock, the Qing Gong, the use of uterotonics, hemostatic agents, sutures or (and) vaginal packing hemostasis and other treatment difficult to control the bleeding emergency interventional embolization hemostasis using superselective internal iliac artery before the branch Tube, angiography with a clear diagnosis of gelatin sponge or debris embolization target artery. Results The success rate of intubation 96.3%, found in 1 case of ectopic uterine artery. There were 22 cases (81.5%) of hemostasis immediately after embolization and 4 cases (14.81%) of gradually hemostasis. The total effective rate was 96.3%. 8 cases combined postpartum DIC, 1 case with multiple organ injury; 11 cases of hemorrhagic shock were rescued successfully. 1 case of uterine artery can not be found, and replaced by hysterectomy. This group of non-embolic complications and mortality. Conclusion Emergency interventional embolization is an ideal method to rescue life-threatening postpartum hemorrhage. It can not only save the life of the woman, but also keep the maternal uterus. It is also worthy of popularization and application to rescue postpartum DIC