산후출혈로 인한 응급 자궁절제술의 적용 및 예후
Prognosis and indication of emergency hysterectomy following postpartum hemorrhage
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목적산후출혈로 응급 전자궁절제술을 시행받은 환자와 보존적 치료를 시행받은 환자의 임상양상과 예후를 비교 분석해 보고자 한다. 연구방법2004년부터 2011년까지 개인병원 및 본원에서 분만 이후 발생한 일차성 산후출혈로 치료받았던 환자들 중 본원에서 자궁을 절제한 환자29명과 자궁을 보존한 39명을 포함한 68명을 대상으로 의무기록을 통하여 후향적 분석을 시행하였다결과산후출혈로 자궁을 절제한 환자와 자궁을 보존한 환자 간의 평균연령, 체질량지수, 분만력, 산후출혈의 원인 및 유도분만의 유무는 차이가없었다. 그러나 자궁절제술 환자에서 내원 시 더 낮은 평균혈압(83.62/48.01 ± 19.16/21.68 mm Hg vs. 96.10/64.12 ±16.17/22.8 mm Hg), 높은 평균 심박동수(114 ±21.68/min vs. 96.10 ± 22.8/min), 낮은 혈색소농도(6.99 ± 3.06 g/dL vs. 8.34 ± 2.1 g/dL)를 보이며 자궁을 보존한 환자들과 통계적 유의한 차이를 나타냈다(P = 0.0007, 0.0017, 0.0358). 결론산후출혈 환자가 혈역학적으로 불안정할수록 응급 전자궁절제술의 가능성이 높았고, 응급 전자궁절제술을 시행한 군은 재원기간도 길고합병증 발생률도 높았다. 따라서 분만 후 활력징후, 자궁수축 및 질출혈에 대한 잦은 모니터링을 통해서 활력징후가 불안정화되기 전에 적절한 처치를 시행한다면, 불필요한 자궁절제술을 막고 산후출혈로 인한 불량한 예후를 최소화할 수 있을 것으로 생각된다.
Abstract
Objective To compare the clinical characteristics and the prognosis between emergency hysterectomy and conservative treatment following postpartum hemorrhage. Methods Primary postpartum hemorrhage was identified in 68 patients who treated in our hospital after delivery at Inje University Busan Paik Hospital and local hospital between 2004 and 2011. 29 patients of these were performed emergency hysterectomy and 39 patients conserved uterus. Clinical characteristics and prognosis of postpartum hemorrhage were reviewed and analyzed with medical records. Results There were no difference of mean age, body mass index, parity, causes of postpartum hemorrhage (PPH), and labor induction between hysterectomy and conservative treatment. The hysterectomy patients had lower blood pressure (83.62/48.01 mm Hg ± 19.16/21.68 mm Hg vs. 96.10/64.12 mm Hg ±16.17/22.8 mm Hg), higher heart rate (114 ± 21.68/min vs. 96.10 ± 22.8/min), and lower hemoglobin concentration (6.99 ± 3.06 g/dL vs. 8.34 ± 2.1 g/dL) than the patients with conservative treatment (P=0.0007, 0.0017, 0.0358, respectively). Hysterectomy group had a longer hospital stay, much more management in intensive care unit (ICU) and more complications than conservative group (P=0.0004, <0.0001, 0.0049, respectively). Conclusion If patients with postpartum hemorrhage were hemodynamically unstable, it is more possible to be performed the emergency hysterectomy. Emergency hysterectomy was associated with a longer hospital stay and more complications. Therefore we consider that early recognition of PPH with frequent monitoring of vital sign, uterine contraction and vaginal bleeding is able to reduce unnecessary hysterectomy and minimize potentially serious outcomes.
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