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目的探讨胎盘早剥并发子宫卒中的防治方法。方法分析行剖宫产的85例胎盘早剥患者的临床资料,并对有子宫卒中的36例(观察组)和无子宫卒中的49例(对照组)患者的特点进行比较。结果3例行子宫次全切除,其余成功地保留了子宫,无一例产后出血。观察组与对照组诱因以妊娠高血压为第一位,但观察组机械性因素、胎盘附着于后壁和确诊时间>24h者明显高于对照组(P<0.05或P<0.01)。症状和体征比较,观察组腹痛明显少于对照组(P<0.01),而腰背痛明显多于对照组(P<0.01)。结论重视发生胎盘早剥的诱因,特别是机械性因素,努力杜绝医源性因素;提高对胎盘早剥的早期诊断是防止子宫卒中的关键;子宫卒中不是子宫切除的指征。尽可能地保留子宫,以保护产妇日后的身心健康。
Objective To investigate the prevention and treatment of placental abruption complicated by uterine stroke. Methods Clinical data of 85 patients with placental abruption who underwent cesarean delivery were analyzed. The characteristics of 36 patients with a uterine stroke (observation group) and 49 patients without a uterine stroke (control group) were compared. Results 3 cases of subtotal hysterectomy, the rest successfully retained the uterus, no case of postpartum hemorrhage. In the observation group and the control group, the cause of pregnancy-induced hypertension was the first, but the mechanical factors in the observation group, the attachment of the placenta to the posterior wall and the diagnosis time> 24h were significantly higher than those in the control group (P <0.05 or P <0.01). The symptoms and signs in the observation group were significantly lower than those in the control group (P <0.01), while those in the control group were significantly higher than those in the control group (P <0.01). CONCLUSION: The causes of placental abruption, especially the mechanical factors, should be emphasized in order to prevent the iatrogenic factors. To improve the early diagnosis of placental abruption is the key to preventing uterine stroke. Uterine stroke is not an indication of hysterectomy. Keep the uterus as much as possible to protect the maternal future physical and mental health.