凶险性前置胎盘127例临床分析  

Clinical analysis of 127 cases of pernicious placenta previa

作　　者：王英兰[1,2] 王硕石[1,2] 张海鹰[1,2] 杨斌[1,2] 王芳[1,2] 

机构地区：[1]暨南大学附属第二临床医学院 [2]深圳市人民医院产科,广东深圳518020

出　　处：《暨南大学学报（自然科学与医学版）》2015年第4期348-352,共5页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：深圳市科技创新计划资助项目(JCYJ20140416122812042)

摘　　要：目的:探讨凶险性前置胎盘的围手术期的高危因素及应对策略.方法:对127例凶险性前置胎盘的病例产前出血、术中出血、围手术期出血、子宫切除率、及其他母儿严重并发症进行分析.根据前置胎盘类型分为:中央性前置胎盘组与部分行前置胎盘组.根据术中胎盘剥离情况分为:胎盘植入组、胎盘粘连组及正常剥离组.结果:(1)胎盘植入率:中央组为49.5%,明显高于部分组胎盘植入率23.1%(P<0.05).(2)围手术期出血:中央组平均为1 800 m L,高于部分组平均1 128 m L(P<0.01).胎盘植入组平均2 636 m L,胎盘粘连组平均1 342 m L,胎盘正常剥离组平均822 m L,各组间均有统计学差异(P<0.01).(3)输血情况:胎盘植入组有98.2%患者术后接受输血治疗,平均输血量2 255 m L,胎盘粘连组有88.2%患者接受输血,平均1 267 m L,正常剥离组有53.7%患者接受输血,平均1 165 m L,胎盘植入组明显高于粘连组(P<0.05)及正常剥离组(P<0.01),而粘连组与正常剥离组比较无统计学差异(P>0.05).(4)子宫切除情况:中央组为34.7%,高于部分组15.4%(P<0.05).胎盘植入组为62.5%,明显高于胎盘粘连与正常联合组5.6%(P<0.05).(5)预后:产妇有1例术中出现心脏骤停经抢救预后良好,1例新生儿畸形死亡,其余母儿预后均良好.结论:凶险性前置胎盘胎盘植入率高,合并中央性前置胎盘者,出血是最主要的风险,大量输血准备及果断行子宫切除术是手术成功的关键.Aim: To evaluate the risk factor of percinious placenta previa and to explore the strategies of management. Methods: The data of 127 patients with percinious placenta previa were studied. Blood loss,blood transfusion in and peri operation,the rate of hysterectomy,and other serious complications of maternals and neonates were analyzed. The patients were divided into two groups: completed placenta previa( CPP) group and partial placenta previa group( PPP). Based on the separation of the placenta from the uterine wall,the patients were also divided into 3 groups: placenta increta group,placenta accreta group and normal separation group. Results:( 1) Rate of placenta increta. The rate of placenta increta was found to be 49. 5% in the CPP group,significantly higher than that of PPP group,which was23. 1%( P < 0. 05).( 2) Peri-operation blood loss. The average of blood loss was 1 800 m L in CPP group,while 1 128 m L in PPP group( P < 0. 01). An average of 2 636 m L of blood loss was found inplacenta increta groups,and 1 342 m L in the placenta accreta group,comparing to 822 m L in the normal separation group( P < 0. 01).( 3) Blood transfusion. 98. 2% patients of the placenta increta group were treated with blood transfusion,while 88. 2% of the acrreta group and 53. 7% of the normal separation group accepted blood transfusion. The average of the amount of blood transfusion was 2 255 m L for increta group,higher than that of accrete group which was 1 267( P < 0. 05),and that of the normal separation group was 1 165 m L( P < 0. 01). There was no statistical difference between accrete and normal groups.( 4) Hysterectomy. The rate of hysterectomy was found to be 34. 7% in CPP group,while15. 4% in PPP group( P < 0. 05). However,62. 5% of hysterectomy was found in the increta group,which was significantly higher than the acrreta and normal group 5. 6%( P < 0. 05).( 5) Prognosis. One patient who suffered from cardiac arrest had been successfully saved with good prognosis. All other mothers and neonates were healthy up to now ex

关 键 词：凶险性前置胎盘 胎盘植入 产后出血 子宫切除 

分 类 号：R714.7[医药卫生—妇产科学]