产后出血的治疗进展钟艳芳.docxVIP

产后岀血的治疗进展钟艳芳 钟艳芳(广东省惠东县人民医院妇产科516300) 【摘要】产后出血是指胎儿娩出后24 h内，经阴道流出的血量超过500 mlo多 发牛在产后2h内，发牛率占产妇总数的2%?5%,是分娩期严重并发症，是产 妇死亡的主要原因之一,在我国居产妇四大死亡原因之首位［1］。通过积极治疗， 其中90%产妇可以避免死亡。积极治疗及预防产后出血是降低孕产妇死亡的一个 很重要的措施。引起产后出血的原因依次为子宫收缩乏力、胎盘因素、软产道裂 伤及凝血功能障碍，产后出血的治疗原则是针对病因，迅速止血，补充血容量纠 正休克及防止感染。近年来，药物及手术治疗产后岀血有了很大发展，特别是手 术治疗方面。 【关键词】 产后出血;药物及手术治疗Development in treatment of postpartum hemorrhage Zhong Yanfang 【Abstract 】Postpartum hemorrhage refers to the delivery of the fetus after 24 h, vagi nal outflow of blood over 500 ml. Occurred in the post natal 2 h, incide nee of total maternal total 2% ~ 5%, the delivery period is the serious complications, is one of the main causes of maternal death, in our country the four leading cause of death in the maternal first (1) by la. By active treatment, of which 90% maternal can avoid death. The active treatment and prevention of postpartum hemorrhage is to reduce the maternal mortality is a very important measure. Cause the cause of postpartum hemorrhage were uterine atony, placental factors, laceration of birth canal and coagulation disorders, postpartum hemorrhage treatment principle is the cause of disease, rapid hemostasis, supplement blood volume correction of shock and prevent infection. In recent years, drug and operation treatment of postpartum hemorrhage had very great progress, especially the operation treatment. 【Key words］ Postpartum hemorrhage; Drug treatment and operation 【中图分类号】R714.46［文献标识码】A【文章编号】1007-8231 (2011) 07-0625-02 1产后出血的预防 1.1重视产前保健，加强孕前及孕期保健工作，对有凝血功能障碍和可 能影响凝血功能疾病的患者，应积极治疗后再受孕，加强对孕产妇孕前、孕期宣 教，进行孕期检查，对有产后出血高危因素患者，如前置胎盘、巨大胎儿、羊水 过多、子宫手术史、子宫畸形、妊娠期高血压疾病、妊娠胆汁淤积综合征(ICP)、 胎盘早剥、高龄产妇、多次妊娠及以前曾有产后出血病史者要加强产前检查，提 前住院。对于ICP患者，从产前1周至产后1周补充维生素K,可减少产后出血 的发生［5］o 1.2严密观察及正确处理产程，经阴道分娩的产妇，第一产程合理使用 宫缩药和镇静剂，注意产妇饮食，防止产妇过度疲劳及产程过长。第二产程认真 保护会阴，正确指导产妇屏气及使用腹压，避免胎儿娩出过快。 2产后出血的治疗 原则是针对病因，迅速止血，补充血容量纠正休克及防止感染。 2.1宫缩乏力引起的产后出血。 2.1.1 规治疗方法是按摩子宫，催产素20U子宫体直接肌肉注射，或 20U催产素加入平衡液500ml中静脉滴注，滴速40-100滴/min。产后应用催产 素也可以肌内注射、宫颈注射。 2.1.2前列腺素衍生物的应用 2.1.2.1米索前列醇是一种前列腺素EI(F