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目的:探讨剖宫产术中大出血的处理方法。方法:对22例子宫下段剖宫产术中大出血病例的临床资料进行回顾性分析。结果:出血量500～2500mL,其中500～799mL10例(45%),800～999mL5例(23%),1000～2500mL7例(32%)。21例行腰硬膜外阻滞联合麻醉,1例因术前已有大出血而行气管插管静吸复合全身麻醉。术中经用缩宫素、麦角新碱、宫腔填塞、肌层逢合、肛塞米索前列醇等方法,止血效果明显,予及时快速输液、输血,补充有效的血容量,适当应用升压药维持循环稳定,保持各重要器官功能的有效灌注。经综合治疗,无1例死亡。结论:做好术前准备,术中快速妥善处理及维持围手术期产妇的循环稳定,是治疗剖宫产术中大出血的关键。
Objective: To explore the treatment of bleeding during cesarean section. Methods: A retrospective analysis was performed on the clinical data of 22 cases of massive bleeding in the lower uterine segment of cesarean section. Results: The amount of bleeding was 500-2500 mL, of which 500-799 mL was 10 (45%), 800-999 mL was 5 (23%), and 1000-2500 mL was 7 (32%). Twenty-one patients underwent epidural block combined with anesthesia and one patient underwent general anesthesia with tracheal intubation and static suction due to preoperative hemorrhage. Intraoperative use of oxytocin, ergonovine, uterine cavity packing, muscle layer coincide, anal plug misoprostol and other methods, bleeding effect is obvious, to prompt infusion, blood transfusion, blood volume supplement, the appropriate application of L Pressure drugs maintain a stable circulation and maintain the effective perfusion of vital organs. After comprehensive treatment, no one died. Conclusion: Preoperative preparation, rapid and proper intraoperative management and maintenance of perioperative maternal circulation stability, is the key to treatment of bleeding in cesarean section.