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目的探讨盆腔填塞术在产后出血合并弥散性血管内凝血(DIC)患者中的应用价值。方法回顾性分析2008年6月至2012年12月在产科住院的产后出血合并DIC患者32例的临床资料,行子宫切除术中手术创面渗血不止,给予积极行盆腔填塞术。结果 32例盆腔填塞时间48~72 h,平均62.4 h;凝血常规、血小板等指标术后24~48 h恢复正常,盆腔引流液均为淡血水,计100~1 500 ml;术后3~4 d盆腔引流管均顺利拔除,腹部切口均无渗血;病情平稳后在静脉麻醉下抽出填塞的无菌绷带及油纱均顺利。所有患者术后均无发热,腹部切口均甲级愈合,无再次盆腔内出血。术后7 d复查盆腔B超及双肾B超均无异常发现;术后3个月复诊,所有患者均无肠粘连等并发症。结论盆腔填塞术操作简便,止血确切、迅速,是抢救急危产后出血合并DIC患者的一种选择。
Objective To investigate the value of pelvic packing in patients with postpartum hemorrhage complicated with disseminated intravascular coagulation (DIC). Methods The clinical data of 32 patients with postpartum hemorrhage complicated with DIC admitted in obstetrical department from June 2008 to December 2012 were retrospectively analyzed. Surgical wound bleeding during hysterectomy was performed, and pelvic tamponade was performed actively. Results The pelvic filling time of 32 patients was 48-72 h (mean 62.4 h). The indexes of coagulation routine and platelet returned to normal after 24-48 h, and the pelvic drainage fluid was pale water, which was 100-1 500 ml. The postoperative 3 ~ 4 d pelvic drainage tube were successfully removed, abdominal incision no bleeding; after the condition was stable under the venous anesthesia out of the sterile packing gauze and gauze were smooth. All patients had no fever after surgery, abdominal incision were grade A healed, no recurrence of pelvic hemorrhage. There was no abnormal findings of B-ultrasound and B-ultrasound of the pelvis on the 7th day after operation. The patients were referred at 3 months after operation and no complications such as intestinal adhesion were found in all patients. Conclusions Pelvic packing is simple and convenient to operate, and the hemostasis is exact and rapid. It is an option to rescue patients with DIC after hemorrhage in emergency.