晚孕期胎盘植入止血技术应用分级583例分析  

Clinical application grading of hemostasis techniques in 583 patients with placenta accreta during the third trimester

作　　者：段思 黄靖锐 彭巧珍[1] 李逊 张卫社[1] DUAN Si;HUANG Jing-rui;PENG Qiao-zhen;LI Xun;ZHANG Wei-she(Department of Obstetrics and Gynecology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院妇产科,湖南长沙410008

出　　处：《中国实用妇科与产科杂志》2018年第10期1143-1148,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家"十二五"科技支撑计划项目(2014BAI05B05);湖南省科技计划项目(2017SK2151;2017SK1033)

摘　　要：目的探讨晚孕期胎盘植入止血技术应用分级及其对母婴结局的影响。方法回顾性分析2013年1月1日至2016年12月30日中南大学湘雅医院收治的晚孕期、保留胎儿、剖宫产终止妊娠、资料完整的583例胎盘植入病例,依据应用的止血技术分级,分为子宫性止血组(UH,n=396)、血管结扎性止血组(UVL,n=108)、介入性血管栓塞性止血组(UIE,n=23)和子宫切除性止血组(UHT,n=56);比较4组孕产史、植入程度、出血量、输血量、母体近远期并发症及新生儿结局。结果 4组孕产次、流产次、前次剖宫产次、瘢痕子宫比例、植入程度、出血量、输血量、母亲转ICU差异有统计学意义(P<0.05),且四级止血技术应用与产次、前次剖宫产次数、距前次剖宫产时间有相关性(P<0.001)。而母体远期并发症、分娩孕周、早产率、新生儿体重、Apgar评分差异无统计学意义(P>0.05)。四级止血技术与不良妊娠结局的二元logistic回归显示:较UH组,UVL、UIE、UHT组有较高术中大量出血、输血、母亲转ICU风险。结论孕晚期保留胎儿的胎盘植入,需多种止血技术联合应用,但需加强并发症预防,对极严重病例果断切除子宫,只要技术选择合适可减少其他并发症发生。Objective To investigate the clinical application grading of intraoperative hemostasis techniques in patients with placenta accreta during the third trimester and its effect on maternal and neonatal outcomes.Methods The clinical data of 583 patients with placenta accreta in Xiangya Hospital,Central South University between Jan. 1,2013 and Dec.30,2016 were analyzed retrospectively.According to the clinical application grading of hemostasis techniques,583 patients were divided into uterine hemostatisis group（UH,n=396）,uterine＋vascular ligation hemostasis group（UVL,n=108）,uterine＋interventional embolization hemostasis group（UIE,n=23）and uterine hysterectomized hemostasis group（UHT,n=56）.Compare the maternal history,depth of placental implantation,intraoperative blood loss,transfusion volume,postoperative short-and long-term complications and neonatal outcomes.Results Significant statistical differences were found in the number of gravidity,parity,abortions and anterior cesarean section,ratio of scars to uterus,depth of placental implantation,the amount of blood loss and transfusions and the rates of ICU transferation（P〈0.05）.The gestational weeks,birth weights,Apgar score and the rates of preterm birth and maternal long-term complications had no statistical difference among 4 groups（P〈0.05）.The binary logistics regression analysis of the four-stage hemostasis technique and the adverse maternal and neonatal outcomes showed that the UVL,UIE,and UHT groups had relatively high risk of intraoperative massive bleeding,blood transfusion,and ICU transferation compared with the UH group.Conclusion For severe placenta accreta with fetus during the thirdtrimester, a combination of multiple techniques should be used to stop bleeding and obtain the opportunity to retain the uterus. Meanwhile, efforts must be made to prevent complications. For very serious cases, hysterectomy should be used to reduce the occurrence of other complications.

关 键 词：胎盘植入 凶险性前置胎盘 子宫切除 产后出血 止血技术 

分 类 号：R714[医药卫生—妇产科学]