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Dołączył: 03 Mar 2011
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 Wysłany: Wto 9:10, 22 Mar 2011 Temat postu: adidas scarpe xvc xyb tkx fcb |
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Late induction of placenta previa acute DIG 1 例
Veins of lower uterine segment combined anesthesia for cesarean section. When removing the fetus had died of intraoperative bleeding surface of placental separation. To intravenous infusion of oxytocin 40U, myometrium oxytocin 30U, uterine gauze and other treatment, the bleeding is still more than. Poor uterine contraction, diverted hysterectomy surgery. After hysterectomy, more than stump bleeding, blood coagulation is not, surgery can not get blood through veins. Diverted to the femoral artery puncture for blood tests show blood: WBC: 12.6x109 / L, RBC: 1.59x102 few, Hg: 48g / L,[link widoczny dla zalogowanych], P: 53x109 / L, consider the acute DIC. Immediately by a higher hospital expert consultation. Stump suture hemostasis results are poor, use hot salt water gauze to stop bleeding of more than 2h, intraoperative blood loss of about 3800ml, enter the cryoprecipitate, fresh blood, platelet, red blood cells, plasma and other blood components were 6800ml, no bleeding observed after the wound uterus rectum nest placed drainage strip, conventional abdomen was closed. During and after the slow intravenous infusion of dopamine to maintain BP> 80/50mmHg. 2 days after surgery, the patient got better, no intra-abdominal bleeding,[link widoczny dla zalogowanych], postoperative drainage and removal of Article 48h, review the routine blood test showed: Hg: 84g, L, RBC: 2.66x102 / I,, PLT: 79x109 / L. 7d after suture removal. Class incision healing. Blood discharge showed: WBC: 5.2x109 / L, RBC: 4.26 ~ 102, RT, Hg: 125, PLT: 280xlOg / L, due to left lower extremity numbness patients, recovered in hospital after 62d. 2 Acute DIC is a discussion of obstetric larger quantities due to acute fetal components into the maternal blood circulation caused by coagulopathy. Mainly for shock, bleeding, organ dysfunction syndrome. At present, has become the leading cause of maternal mortality, but also 11O Chinese medicine bow workers reported CHINAMEDICALHERALD obstetric a major issue to be resolved. The cases in recent 8h rescue, so that patients illness turned the corner. In dealing with the following conclusions: ① placenta previa is most often caused by obstetric DIC of a disease, a history of previous cesarean section had even more dangerous, the induction time should be strictly controlled, carefully chosen abortion method. Use of misoprostol induction of labor in this case is not desirable. There are individual differences due to misoprostol, drug dose not control, such as the contraction is too strong, can be amniotic fluid and other procoagulant quickly pressed into the broken blood vessels, into the maternal circulation, stimulate blood clotting mechanism, resulting in DIC. ② should have good medical care equipment, hospital induced labor, can quickly establish smooth channels and is equipped with a large number of venous blood, where the case is of the deepest feelings: for patients with type AB blood group, blood bank stored blood is not enough, without violation of ③ patients in the emergency admission,[link widoczny dla zalogowanych], the degree of shock,[link widoczny dla zalogowanych], blood loss than the estimate of a serious, immediate blood transfusion, infusion and other life-saving treatment, and a slight improvement in the shock, the choice to terminate pregnancy, cesarean section in a timely manner. Intraoperative massive bleeding found in the uterus, uterine atony, the decisively hysterectomy, thus avoiding the procoagulant greater access to maternal blood circulation, increase the DIC. ④ in the preoperative, intraoperative and postoperative import large quantities of cryoprecipitate, platelets, red blood cells and other components of blood and fresh blood, and the postoperative use of dopamine plus furosemide decreased serum creatinine, diuretic and blood pressure, improve the microcirculation as soon as possible The perfusion and oxygen supply to tissues and organs. Correct coagulation disorders and acidosis at the same time, avoiding the kidney and other organs of failure,[link widoczny dla zalogowanych], is the case that the key to successful treatment. Is the main reason for patients to recover faster. ⑤ rescue work should be orderly, preoperative patients and their families should explain the condition and surgical risk, the arrangement with experienced obstetrician came to power operation, consultation and actively organize the rescue work. ⑥ Cai Jie l2l lines such as placenta previa has been reported that uterine artery embolization. Then given mifepristone plus misoprostol induction of labor, induction time is short, less postpartum bleeding. Few complications, and thrombosis in 2 to 4 weeks through the blood vessels can be further retained the patient's menstrual and reproductive function, so. Induction of labor in patients with placenta previa, one to the intervention treatment and the hospital can quickly perform emergency treatment. [
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