择期手术和急诊手术对胎盘植入治疗的效果及妊娠结局  

Comparison of clinical efficacy and pregnancy outcome between selective and emergency caesarean section in placenta implantation patients

作　　者：卢红梅 孙丽洲[1,2] 葛志平[1,2] 

机构地区：[1]南京医科大学第一附属医院 [2]江苏省人民医院产科,江苏南京210029

出　　处：《中国妇幼保健》2014年第5期674-677,共4页Maternal and Child Health Care of China

基　　金：江苏省"十二五"科教兴卫医学重点学科项目〔苏卫科教(2011)12号文〕

摘　　要：目的：比较择期手术和急诊手术对胎盘植入患者的临床疗效及围手术期结局的影响。方法：选择2010年8月-2013年7月南京医科大学第一附属医院产科收治的58例剖宫产终止妊娠的胎盘植入患者，按照手术时机分为择期手术（22例）和急诊手术（36例）两组，对比两组患者的手术疗效及不同手术时机对妊娠结局的影响。结果：择期手术组患者产后24h出血量显著低于急诊手术组（t=3．524，P〈0．05），并且择期手术组患者入住重症监护室发生率也明显低于急诊手术组（X2=4．203，P〈0．05）；而择期手术组患者泌尿系统损伤、子宫切除及二次手术的发生率与急诊手术组相比差异无统计学意义（P〉0．05）。此外，择期手术组患者产褥感染率、晚期产后出血率、β—hCG降至正常时间以及胎盘完全排出时间与急诊手术患者相比差异无统计学意义（P〉0．05）。结论：择期手术能有效降低胎盘植入患者产后出血量及患者人住重症监护室的发生率；手术时机的选择需要结合患者的孕周、术前诊断及出血情况等进行综合评估。Objective： To compare the clinical efficacy and pregnancy outcome between selective and emergency caesarean section in patients with placenta implantation. Methods： The patients with placenta implantation in 2010 August to 2013 July in the hospital were enrolled. And the patients were divided into selective （n = 22） and emergency caesarean section （n = 36） groups. The effect of operation tim- ing on the clinical efficacy and pregnancy outcome were compared. Results： 24 h bleeding of selective caesarean section patients was signifi- cantly lower than that of emergency group （t = 3. 524, P 〈 0. 05 ） . The incidence of admitted to ICU of selective group was lower than that of the emergency group （X2= 4. 203, P 〈 0.05） . While, the rate of pueperal infection, late postpartum hemorrhage, the time of β- hCG were decreased to normal level and placenta completely ruled out time showed no statistical difference in the two groups （P 〉 0. 05 ） . Conclusion： Selective caesarean section can significantly reduce the amount of bleeding and incidence of admitted to ICU in patients with pla- centa implantation. Timing of operation should be decided by comprehensive evaluation of gestation week, diagnosis, pernatal bleeding, etc.

关 键 词：择期手术 急诊手术 胎盘植入 妊娠结局 

分 类 号：R719[医药卫生—妇产科学]