腹主动脉球囊阻断术在凶险性前置胎盘剖宫产中的应用价值  

The clinical value of application of abdominal aortic balloon occlusion in caesarean section of pernicious placenta previa

作　　者：高和平 周曙光 李兵[2] 童铸廷[3] 刘洪梅[1] 

机构地区：[1]安徽医科大学附属妇幼保健院妇产科,合肥230032 [2]安徽医科大学附属妇幼保健院介入科,合肥230032 [3]安徽医科大学第一附属医院肿瘤放疗科,合肥230032

出　　处：《安徽医学》2018年第1期13-16,共4页Anhui Medical Journal

基　　金：国家青年科学基金项目(项目编号:81201743)

摘　　要：目的探讨凶险性前置胎盘剖宫产术前行腹主动脉球囊预置,术中暂时阻断腹主动脉对母婴妊娠结局的影响。方法回顾性分析2012年4月至2017年3月在安徽医科大学附属妇幼保健院产科住院分娩的86例凶险性前置胎盘病例资料。其中,观察组31例,剖宫产术前行腹主动脉球囊预置术,术中暂时行腹主动脉阻断;对照组55例,剖宫产术前未行腹主动脉球囊预置术。比较两组对象术中、术后情况,相关并发症差异及新生儿结局。结果观察组术中出血量为(925.81±513.79)m L,输血量为(412.90±557.82)m L,对照组术中出血量为(1 345.45±841.31)m L,输血量为(786.36±1061.07)m L,差异均有统计学意义(P<0.05);两组对象手术时间、胎盘植入率、新生儿体质量及窒息发生率比较,差异均无统计学意义(P>0.05);在合并胎盘植入的病例中,两组对象手术时间及子宫切除率分别为(81.57±20.07)min、14.3%和(112.25±25.80)min、66.7%,差异均有统计学意义(P<0.05)。结论对于凶险性前置胎盘尤其是合并胎盘植入的对象,剖宫产术前行腹主动脉球囊预置可有效控制术中出血量,减少输血量,缩短手术时间,降低子宫切除风险。Objective To investigate the efficacy of prophylactic abdominal aortic balloon occlusionin cesareansection for the patients diagnosed as pernicious placenta previa. Methods In this retrospective study,data were analyzed for 86 cases of pernicious placenta previa admitted to the hospital from April 2012 to March 2017. The study group(n = 31) underwent prophylactic abdominal aortic balloon placement before cesarean section and occlusion after delivery. The control group(n = 55) received conventional haemostasis during cesarean section. The primary clinical outcomes were compared,including the volume of blood loss during operation,the volume of blood transfusion,operative time,hysterectomy rate,postoperative hospital stay and neonatal asphyxia rate. Results The volume of intraoperative hemorrhage and volume of blood transfusion in study group and control group were(925. 81 ± 513. 79) m L vs(1345. 45 ± 841. 31) m L,(412. 90 ±557. 82) m L vs(786. 36 ± 1061. 07) m L(P < 0. 05),respectively. There was no statistical significance in the operative time,placenta accrete rate,neonatal weight and asphyxia rate(P > 0. 05). In patients with placenta accreta,the operative time and hysterectomy rate in study group were significantly lower than in control group(P < 0. 05). Conclusion Prophylactic abdominal aortic balloon occlusion effectively reduces intraoperative blood loss,transfusion,operative time and hysterectomy rate in patients diagnosed as pernicious placenta previa especially in placenta previa with placenta accreta.

关 键 词：凶险性前置胎盘 腹主动脉球囊 胎盘植入 

分 类 号：R719.8[医药卫生—妇产科学]