血HCG检测在阴道分娩后宫内妊娠残留物清宫术中的价值  

The evaluation of serum human chorionic gonadotropin in uterine curettage of retained products of conceptions after vaginal delivery

作　　者：王利民 唐冬梅 黄璐 侯莉 邓耀 胡志敏 夏艳梅 黄娟 王思义 

机构地区：[1]成都市妇女儿童中心医院产科,四川成都610091 [2]成都市妇女儿童中心医院超声科,四川成都610091 [3]成都市妇女儿童中心医院检验科,四川成都610091 [4]成都市妇女儿童中心医院病理科,四川成都610091

出　　处：《西部医学》2017年第5期685-688,693,共5页Medical Journal of West China

基　　金：成都市医学科研项目(2013039)

摘　　要：目的探讨血绒毛膜促性腺激素(HCG)检测在阴道分娩后宫内妊娠残留物(RPOCs)清宫术中的价值。方法采用回顾性研究方法,将阴道分娩后1cm<RPOCs<3cm的产妇100例根据是否发生晚期产后出血分为清宫组(观察组)与非清宫组(对照组),每组各50例,用化学发光法检测患者血中HCG,用B超检查两组产妇RPOCs大小,对比两组产妇血HCG水平及RPOCs大小差异。结果出院前观察组产时出血、产后出血、产后3天出血、出院前血红蛋白(HGB)与对照组相比,差异无统计学意义(P>0.05)。出院后产褥期内血情况比较,观察组阴道出血量较对照组多、阴道出血时间较对照组长、最低HGB较对照组低,差异有统计学意义(P<0.01)。观察组血HCG为(3052.35±1358.56)mIU/ml对照组为(992.70±245.46)mIU/ml,观察组血HCG明显高于对照组,差异有统计学意义(P<0.01)。观察组92%(46/50)患者血HCG水平>2000.00mIU/ml。观察组RPOCs大小与对照组(2.00±0.48cm vs2.03±0.45cm)相比,观察组RPOCs较对照组小,但差异无统计学意义(P>0.05)。两组患者近期并发症比较,观察组血象与对照组血象发生分别为48.00%和26.00%、发热发生率34.00%和14.00%、败血症发生率16.00%和2.00%、贫血发生率60.00%和22.00%、重度贫血发生率22.00%和0.00%均较对照组高,产后42天子宫完全复旧发生率分别为84.00%和100.00%差异有统计学意义(P<0.01)。结论阴道分娩后1cm<RPOCs<3cm产妇发生晚期产后出血主要与血HCG有关,与RPOCs大小关系不确切,对于血HCG<2000.00mIU/ml产妇出院前不需常规清宫,而血HCG>2000.00mIU/ml产妇出院前予以清宫,可减少阴道分娩后因RPOCs过度清宫或清宫不及时所带来并发症。Objective To evaluate the value of serum human chorionic gonadotropin （HCG） in uterine curettage of retained products of conceptions after vaginal delivery. Method According to the occurrence of late postpartum hemorrhage, all delivery women with the size of RPOCs 1-3cm were divided into uterine curettage group （observational group） and non-uterine curettage group （control group） with 50 cases in each group in this prospective study. The serum concentration of HCG were detected by chemical luminous method and the size of RPOCs were measured by B ultrasonic examination. Results The levels of HCG of women in observational group were significantly higher than those of subjects in control group （3052.35 ＋ 1358.56 vs. mlU/ml 992.70 ＋ 245.46 mIU/ml, P〈0.01）. The proportion of subjects with HCG level more than 2000.00 mIU/ml in observational group was 92% （46/50）. The size of PROCs of women in observational group was little less than those of women in control group （2.00±0.48cm vs. 2.03±0.45 cm） without statistical significance （P〉0.05）. Conclusion The occurrence of postpartum hemorrhage for delivery women with RPOCs 1-3 cm is relevant to the levels of serum HCG, but not to the size of PROCs. It is necessary of conventional uterine curettage for delivery women with blood HCG〉2000.00mIU/ml, but not for blood HCG〈2000.00 mIU/ml to reduce the complications of excessive curettage or delayed curettage.

关 键 词：血HCG 阴道分娩 宫内妊娠残留物 清宫术 晚期产后出血 

分 类 号：R714.46[医药卫生—妇产科学]