凶险型前置胎盘临床分级诊断方法探讨  

Research on clinical grading diagnostic method of pernicious placenta previa

作　　者：郑九生[1] 刘淮[1] 辛思明[1] 沈婷[1] 雷晓真 万凌玲[1] 

机构地区：[1]江西省妇幼保健院产科,江西南昌330006

出　　处：《中国妇幼保健》2014年第33期5374-5376,共3页Maternal and Child Health Care of China

基　　金："十二.五"国家科技支撑计划〔2014BA105B02〕

摘　　要：目的：探讨凶险型前置胎盘临床分级诊断方法,为临床处理提供指导。方法：选取2011年1月~2013年12月在该院分娩的凶险型前置胎盘孕妇146例,根据术中所见并结合术后组织病理学检查进行临床分级,其中Ⅰ级58例、Ⅱ级48例、Ⅲ级19例和Ⅳ级21例,分别设为Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组。比较各组间出血量、输血量及术中止血措施使用情况的差异性。结果：1Ⅱ组出血量及输血量均比Ⅰ组增多（P〈0.05）,Ⅲ组出血量及输血量均比Ⅱ组增多（P〈0.05）,Ⅳ组出血量及输血量均比Ⅲ组增多（P〈0.05）;2Ⅰ组使用一般止血措施多于Ⅱ组（P〈0.05）;Ⅱ组采用保守性手术多于Ⅰ组和Ⅲ组（P〈0.05）;Ⅲ组子宫切除率高于Ⅱ组（P〈0.05）,Ⅳ组子宫切除率高于Ⅲ组（P〈0.05）。Ⅰ组和Ⅱ组患者无泌尿系统损伤,Ⅲ组有2例损伤,Ⅳ组有10例损伤。结论：凶险型前置胎盘临床分级越高凶险程度越高;建议规范术前影像学检查,对凶险型前置胎盘进行临床分级诊断,指导临床处理。Objective： To explorei the clinical grading diagnostic method of pernicious placenta previa, provide guidance for clini- cal treatment. Methods： A total of 146 pregnant women with pernicious placenta previa were selected from the hospital from January 2011 to December 2013, then they were divided into grade Ⅰ group （58 cases）, grade Ⅱ group （48 cases）, grade Ⅲ group （19 cases） and grade IV group （21 cases） according to intraoperative observation and postoperative histopathological examination. The amounts of hemorrhage, blood transfusion volumes and intraoperative bemostatic measures in the four groups were compared. Results ： The amount of hemorrhage and blood transfusion volume in grade Ⅱ group were statistically significantly higher than those in grade Ⅰ group （P 〈 0. 05） . The amount of hemorrhage and blood transfusion volume in grade Ⅲ group were statistically significantly higher than those in grade Ⅱ group （ P 〈 0. 05 ） . The amount of hemorrhage and blood transfusion volume in grade Ⅳ group were statistically significantly higher than those in grade Ⅲ group （ P 〈 0.05 ） . Intraoperative hemostatic measures in grade Ⅰ group were statistically significantly more than those in grade II group （ P 〈 0. 05 ）. The number of cases adopting conservative surgery in grade Ⅱ group was statistically significantly higher than those in grade I group and grade Ⅲ group （ P 〈 0. 05 ）. The rate of hysterectomy in grade Ⅲ group was statistically significantly higher than that in grade Ⅱ group （P 〈 0. 05）. The rate of hysterectomy in grade IV group was statistically significantly higher than that in grade Ⅲ group （ P 〈 0. 05 ）. No urinary system injury occurred in grade Ⅰ group and grade Ⅱ group, while urinary system injury was found in 2 cases in grade Ⅲ group and 10 cases in grade IV group. Conclusion： The higher the clinical grade is, the more dangerous pernicious placenta previa is. It is sug- gested to standardize preope

关 键 词：凶险型前置胎盘 分级诊断 胎盘植入 产科出血 子宫切除术 

分 类 号：R714.2[医药卫生—妇产科学]