疤痕子宫合并中央性前置胎盘的围术期并发症  

Perioperative complications in scar uterus with central placenta previa

作　　者：蔡建云 顾新安 王谨 张雪玲 CAI Jian-yun1,2, GU Xin-an3 , WANG Jin1 , ZHANG Xue-ling4(1.Department of Obstetrics and Gynecology, Yangpu Hospital Affiliated to Tongji University （Shanghai Yang pu District Central Hospital）, Shanghai 200090, China; 2.Nantong University, Jiangsu Nantong 226019, China; 3.Plastic Surgery Department, Shanghai Yi Lai Mei Medical Beauty Hospital, Shanghai 200070, China; 4.Shanghai Yangpu District Mental Health Center, Shanghai 200090, China)

机构地区：[1]上海市同济大学附属杨浦医院上海市杨浦区中心医院妇产科,上海200090 [2]南通大学,江苏南通226019 [3]上海伊莱美医疗美容医院整形美容外科,上海200070 [4]上海市杨浦区精神卫生中心,上海200090

出　　处：《中国妇幼健康研究》2018年第3期349-352,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨疤痕子宫合并中央性前置胎盘的围手术期并发症及处理措施。方法选取上海市同济大学附属杨浦医院2014年1月至2017年1月收治的90例产妇,依据胎盘与子宫附着情况将这些患者分为胎盘植入组(n=30)、胎盘粘连组(n=20)和正常剥离组(n=40)三组,对三组患者的术中出血量、围手术期出血量、输血量、输血、子宫切除、妊娠结局进行统计分析。结果胎盘植入组、胎盘粘连组、正常剥离组患者的输血率分别为96.67%、87.5%、57.5%,子宫切除率分别为66.67%、5.00%、0.00%。胎盘植入组、胎盘粘连组患者的术中出血量、围手术期出血量均显著多于正常剥离组(t值分别为4.303、3.182、2.776、2.571,均P<0.05),而胎盘植入组患者的术中出血量、围手术期出血量又均显著多于胎盘粘连组(t值分别为2.447、2.365,均P<0.05);胎盘植入组、胎盘粘连组患者的输血率均显著高于正常剥离组(χ~2值分别为5.021、7.383,均P<0.05);胎盘植入组患者的输血量显著高于胎盘粘连组、正常剥离组(t值分别为2.447、2.365,均P<0.05),子宫切除率显著高于胎盘粘连组、正常剥离组(χ~2值分别为11.142、12.831,均P<0.05);三组患者的羊水栓塞、心脏骤停、死胎、新生儿窒息发生率及新生儿死亡率比较均无显著性差异(χ~2值分别为0.860、0.760、0.450、0.600、0.450,均P>0.05)。结论疤痕子宫合并中央性前置胎盘患者围手术期具有较高的胎盘植入发生率,子宫动脉栓塞术能够对出血进行有效控制,值得在临床推广使用。Objective To investigate the perioperative complications and treatment measures in scar uterus with central placenta previa. Methods A total of 90 cases of pregnant women admitted in Yangpu Hospital Affiliated to Tongji University from January 2014 to January 2017 were selected and divided into placenta accreta group （n=30）, placenta adhesion group （n=20） and normal dissection group （n=40） according to attachment of placenta and uterus. Intraoperative bleeding volume, perioperative bleeding volume, amount of blood transfusion, blood transfusion, hysterectomy and pregnancy outcomes in three groups were statistically analyzed. Results Blood transfusion rates in placenta accreta group, placenta adhesion group and normal dissection group were 96.67%, 87.5% and 57.5% respectively, and hysterectomy rates were 66.67%, 5.00% and 0.00% respectively. Intraoperative bleeding volume and perioperative bleeding volume in placenta accreta group and placenta adhesion group were significantly higher than those in normal dissection group （t value was 4.303, 3.182, 2.776 and 2.571, respectively, all P〈0.05）, and intraoperative and perioperative bleeding volumns in placenta accreta group were significantly higher than those in placenta adhesion group （t value was 2.447, and 2.365, respectively, both P〈0.05）. Blood transfusion rate in placenta accreta group and placenta adhesion group were significantly higher than that in normal dissection group （χ^2 value was 5.021 and 7.383, respectively, both P〈0.05）. Amount of blood transfusion in placenta accreta group was significantly higher than that in placenta adhesion group and normal dissection group （t value was 2.447 and 2.365, respectively, both P%0.05）, and hysterectomy rate in pacenta acereta group was significantly higher than that in placenta adhesion group and normal dissection group （χ^2 value was 11. 142 and 12. 831, respectively,both P〈 0. 05）. There were no significant differences in incidences of amniotic fluid embolism, cardiac arre

关 键 词：疤痕子宫合并中央性前置胎盘 胎盘植入 胎盘粘连 围手术期并发症 处理措施 

分 类 号：R714[医药卫生—妇产科学]