Objective: To review the clinical aspects and pathogenesis of postpartum hemorrhage (PPH) and investigate the optimal protocols for intervention. Methods: From February 2009 to December 2015, data of normal labour and casearean birth women admitted to intensive care unit (ICU) in our hospital because of hematobilia were selected. 95 patients were divided into three groups (e. g ≥500-1 000 ml, ≥1 000-1 500 ml, ≥1 500-2 500 ml and ≥2 500 ml group) according to the bleeding volume. A retrospective analysis was performed to study the pathogenesis of PPH, organ function, surgical intervention and clinical prognosis on hemorrhage. Results: The data comprised 20 504 women over the 6-year period. 95 (0.463%) of which resulted in PPH and were admitted to ICU. 9 of these patients with PPH unsurvived. The value of creatinine and urea nitrogen, the score of APACHE Ⅱ and the possibility of multiple organ dysfunction syndromethe (MODS) increased with the amount of bleeding (P<0.05). For patients with PPH caused by injury of birth canal and/or placenta factors, there was significant difference among three groups on amount of bleeding (P<0.05). For patients with surgical intervention such as vaginal packing, interventional treatment and exploratory laparotomy conducted in 6 hours, the volume of transfusion was(759±114) ml. The volume of transfusion was (2 000±829) ml and (4 999±1 699) ml in 6 to 12 hours intervention group and in greater than 12 hours intervention group, respectively. The volume of transfusion significant increased over intervention time. There was a statistically significant difference in all groups (P<0.05). Conclusions: Classified treatment should be conducted according the classification on the amount of bleeding. Patients with severe PPH and/or tendency of organ failure should be admitted to ICU. Measures for maintenance of the function of organs are necessary, while appropriate surgical intervention is also needed based on the cooperation between ICU and obstetrical department, and the cure rate could be improved.
目的： 探讨我院重症医学科(ICU)与产科联合治疗的产后出血(PPH)患者的临床特点及干预方案。 方法： 回顾性分析安徽省立医院2009年2月至2015年12月入住产科自然分娩或手术后因产后出血而需要转入ICU加强治疗的产妇的临床资料。依据患者出血量分为出血量≥500～1 000 ml组，≥1 000～1 500 ml组，≥1 500～2 500 ml组和≥2 500 ml组。分层分析患者的出血原因、各器官功能情况、外科干预时机和方式及临床预后等资料。 结果： 共20 504例次，因发生产后出血需入住ICU的患者有95例(0.463%)，其中9例死亡。患者的肾功能水平、急性生理与慢性健康Ⅱ(APACHE Ⅱ)评分和多脏器功能障碍(MODS)可能性随着出血量的增加而升高(P<0.05)；对于出血原因为产道损伤和胎盘因素的患者，其出血量在上述各组间比较差异有统计学意义(P<0.05)；3组间的干预措施比较中，药物治疗和子宫切除例数比较差异有统计学意义(P<0.05)；对需要外科干预解除病因的患者，6 h内，6～12 h及>12 h给予产道填塞、介入或其他外科干预，则住院期间输血量分别为(759±114) ml，(2 000±829) ml，(4 999±1 699) ml，且各组之间出血量差异有统计学意义(P<0.05)。 结论： 依据产后出血量进行临床分级处理，对出血量较大或伴有重要脏器衰竭倾向的孕产妇，应及时转入ICU加强治疗。同时在器官功能维护、各项指标监测与调控等的基础上，与产科密切协作，给予合理的外科干预时机及方案，能提高高危孕产妇救治成功率。.
Keywords: Incidence; Pathogeny; Postpartum hemorrhage; Prognosis.