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主治考试知识考点-产后大出血典型病例1例

2017-05-24 MedSci MedSci原创

“产后大出血”是指胎儿娩出后,经阴道生产的产妇出血超过500毫升,或经剖腹生产的产妇出血超过1000毫升。当产妇失血量达至一定程度,即有可能发生生命迹象不稳定、广泛性凝血功能低下,甚至休克及死亡。产后出血是执业医师、主治医师考试中常见的考点,梅斯小编整理了产后出血典型病例1例,供大家参考!主诉:患者,33岁,G2P1。因产后阴道大量出血8小时由外院转入。[病史概要]该产妇因孕41周于 4月2日住当


“产后大出血”是指胎儿娩出后,经阴道生产的产妇出血超过500毫升,或经剖腹生产的产妇出血超过1000毫升。当产妇失血量达至一定程度,即有可能发生生命迹象不稳定、广泛性凝血功能低下,甚至休克及死亡。产后出血是执业医师、主治医师考试中常见的考点,梅斯小编整理了产后出血典型病例1例,供大家参考!
主诉
患者,33岁,G2P1。因产后阴道大量出血8小时由外院转入。
【病史概要】
该产妇因孕41周于 4月2日住当地医院待产,并于入院当天以延期妊娠予以0.5%浓度缩宫素静滴计划分娩。静滴缩宫素2天无效,于4月4日上午再次以1%浓度缩宫素静滴,下午10时临产,4月5号0时30分宫口开全,0时50分顺产分娩一男婴,体重3600g,胎盘自娩完整,会阴II度裂伤,产后即时阴道出血400ml。检查发现宫颈3点、9点处和阴道左侧壁裂伤,随即缝合止血,并予米索前列醇400ug 和缩宫素20U促宫缩治疗,出血未止。至4月5日上午4时30分累计出血达1600ml。在静脉输液、输血、促宫缩治疗的同时,再次行阴道、宫颈裂伤创口缝合止血,并做清宫术,未见胎盘胎膜残留,事后曾一度出血减少。但观察1小时后,阴道出血又逐渐增加,至4月5日上午8时又出血700ml,心率120次/分,血压90/60 mmHg,急送本院。既往体健。
【体格检查】
体温 37。C,脉搏 120次/分,血压90/60 mmHg,神志清,面色苍白,重度贫血貌。心率120次/分,律齐,会阴裂口已缝合,阴道内积血块约400ml,宫颈3点、9点处裂伤,阴道左侧壁裂伤,深达穹隆,均已缝合,但仍有渗血,宫腔仍有出血自宫颈口流出,宫底脐下一指,轮廓清晰,质硬,左侧宫旁有压痛。
【辅助检查】
血常规:WBC 23.9*109/L,N0.91,L 0.037, PLT 60*109/L,RBC 1.71*1012/L ,HB 46g/L。凝血功能:活化部分凝血活酶时间 48.5秒(正常27.0-41.5秒),纤维蛋白原定量0.77g/L(正常2-4 g/L),凝血酶原时间23.1秒(正常11.2-15.3秒)。B超:子宫左侧见混合回声5 cm *5 cm *7cm。
更多此病例详情请点击:考点回顾-产后大出血病例1例

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    2017-05-27 往日如昨

    学习了谢谢分享

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    2017-05-26 往日如昨

    继续学习中谢谢分享

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