重症产后出血40例临床分析

Clinical analysis of 40 cases of severe postpartum hemorrhage

摘要:

目的：探讨重症产后出血进入中心重症监护室（intensive care unit，ICU）的影响因素、重症产后出血母儿结局及产科危急重症处理。方法：回顾性分析2010年1月-2012年12月重庆医科大学附属第一医院收治的243例产后出血患者中进入中心ICU的40例重症产后出血患者的临床特点。结果：本组中进入中心ICU监护者40例占产后出血者16.46%（40/243）。我院分娩的重症产后出血者分娩方式均为剖宫产。进入ICU原因为失血性休克、胎盘植入、心功能不全、甲亢合并轻度子痫前期及心肺复苏术后。产后出血量大于2 000 ml 者24例（24/40，60.00%）。多数患者合并至少一个系统或器官功能障碍，最常见的是弥漫性血管内凝血（diffuse intravascular coagulation，DIC）。进入中心ICU产妇平均输注红细胞悬液（2 544.74±782.60） ml，血浆（1 484.85±951.0） ml，血小板（2.70±2.30） U，冷沉淀（7.30±10.20） U。使用鼻导管吸氧14例，占35.00%，无创呼吸机辅助通气4例，占10.00%，有创呼吸机辅助通气22例，占55.00%。1例因严重DIC抢救无效死亡。围生儿病死率为52.63‰。结论：失血性休克是产后出血产妇进入ICU的主要原因。重症产后出血是导致DIC的重要原因之一，子宫切除率高。密切生命支持和成分输血是重症产后出血治疗中的重要措施。产科医务人员与重症监护医护人员的合作是救治危重孕产妇的有效途径。

Abstract:

Objective：To evaluate the risk factor and clinical outcome of severe postpartum hemorrhage（PPH） admitted in ICU and treatment for obstetrics emergency cases. Methods：Retrospective analysis was made in 40 cases of severe PPH admitted in The First Affiliated Hospital of Chongqing Medical University from January 2010 to December 2012. Results：Severe PPH cases admitting in ICU accounted for 16.46% of PPH patients（40/243）. Delivery way of all 243 PPH patients was caesarean section. Main reason of se－vere PPH patients admitting in ICU was hemorrhagic shock，followed by placenta increta，cardiac insufficiency，hyperthyroidism com－plicating with mild eclampsism and cardiorespiratory resuscitation. Twenty-four cases（60.00%，24/40） got bleeding over 2 000 ml. Most patients got at least one system or organ dysfunction and diffuse intravascular coagulation（DIC） was the most common. Severe PPH patients were infused with packed red blood cells（2 544.74±1 782.60） ml，plasma（1 484.85±951.0） ml，platelet （2.7±2.3） U and cryoprecipitate（7.30±10.2） U. Fourteen cases（35.00%，14/40） used nasal oxygen catheters for oxygen，4 cases（10.00%，4/40） used non-invasive ventilator，22 cases（55.00%，22/40） used invasive ventilator. Neonatal case-fatality rate in our hospital was 52.63‰. Conclusions：Main reason of severe PPH patients admitting in ICU is hemorrhagic shock. Severe PPH is one of the important causes of DIC.Intensive life support and component transfusion are the important steps to cure severe PPH. Cooperation between ICU staff and obstetrician is also the effective way to treat critical pregnancies.