剖宫产术中娩出胎儿前膀胱下推法在凶险性前置胎盘手术中的应用效果  

Application of pushdown bladder before fetal delivery in patients with pernicious placenta previa during cesarean section operation

作　　者：孙美果[1] 王艳玲[1] 尹宗智[1] 陈娅[1] 杨媛媛[1] SUN Meiguo;WANG Yanling;YIN Zongzhi(Department of Obstetrics & Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China)

机构地区：[1]安徽医科大学第一附属医院妇产科

出　　处：《安徽医学》2019年第5期481-484,共4页Anhui Medical Journal

基　　金：国家自然科学基金资助项目(项目编号:81300514)

摘　　要：目的评价剖宫产手术时娩出胎儿前膀胱下推法在凶险性前置胎盘手术中的应用效果。方法选择2016年1月至2017年12月安徽医科大学第一附属医院产科收治凶险性前置胎盘孕产妇89例,根据剖宫产时下推膀胱的时机不同,分为A组(47例)与B组(42例),A组为娩出胎儿前膀胱下推组,B组为娩出胎儿后下推膀胱组。比较两组孕产妇一般情况(年龄、孕次、产次、孕周、胎盘植入率)、平均手术出血量、平均输血量、手术时间、术后住院时间、产褥病率、子宫切除、膀胱损伤和新生儿窒息方面的差异。结果A、B组孕产妇术中出血量分别为(1927.76±356.31)mL、(2859.55±477.80)mL,输血量分别为(861.72±91.58)mL、(1285.73±162.69)mL,手术时间分别为(1.83±0.87)h、(2.71±0.94)h,术后住院时间分别为(5.37±1.72)d、(6.83±1.56)d,产褥病率分别为10.64%、28.57%,子宫切除率分别为14.89%、35.71%,新生儿窒息发生率分别为4.26%、19.05%,两组差异有统计学意义(P<0.05)。结论凶险性前置胎盘娩出胎儿前膀胱下推法疗效满意,值得临床推广应用。Objective To explore the effects of pushdown bladder before fetal delivery during cesarean section(CS) complications of pernicious placenta previa(PPP). Methods Eighty-nine cases of PPP hospitalized in the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2017 were selected and divided into two groups according the time of pushdown bladder during CS, namely group A (pushdown bladder before fetal delivery, 47 cases) and group B (pushdown bladder after fetal delivery,42 cases). We analyzed the general information of the two groups (age, gravidity, parity, gestational weeks, clinical placenta implantation rate), operation blood loss, average blood transfusion, operation time, postoperative hospital stay, puerperal morbidity, hysterectomy, bladder injury and neonatal asphyxia. Results The average operation blood loss of two groups was (1 927.76±356.31)mL vs (1 285.73±162.69)mL, blood transfusion was (861.72±91.58)mL vs ( 1 285.73 ±162.69)mL, operation time was (1.83±0.87)h vs (2.71±0.94)h, postoperative hospital stay was (5.37±1.72)d vs ( 6.83± 1.56)d, puerperal morbidity was 10.64% vs 28.57%, hysterectomy was 14.89% vs 35.71% and neonatal asphyxia was 4.26% vs 19.05%, and there was significant difference between the two groups( P <0.05). Conclusions Pushdown bladder before fetal delivery during the CS of PPP is an effective method and worth clinical spreading.

关 键 词：凶险性前置胎盘 膀胱下推法 产后出血 子宫切除 

分 类 号：R719.8[医药卫生—妇产科学]