腹主动脉球囊阻断时机对凶险性前置胎盘剖宫产术中出血及子宫切除率的影响  

Effects of the timing of abdominal aortic balloon occlusion on hemorrhage and hysterectomy rate during cesarean section of dangerous placenta previa

作　　者：万红芳 李傲霜 马骏 程碧辉[1] 何艳[1] 吴娟 WAN Hong-fang;LI Ao-shuang;MA Jun;CHENG Bi-hui;HE Yan;WU Juan(Department of Obstetrics,the Third People's Hospital of Mianyang,Sichuan Provinical Mental Health Center,Mianyang 621000,Sichuan,CHINA)

机构地区：[1]绵阳市第三人民医院产科四川省精神卫生中心,四川绵阳621000

出　　处：《海南医学》2020年第15期1979-1981,共3页Hainan Medical Journal

摘　　要：目的探讨凶险性前置胎盘剖宫产术中腹主动脉球囊阻断时机的选择对术中、术后出血以及子宫切除率的影响。方法选取2017年1月至2019年10月期间绵阳市第三人民医院产科收治的92例凶险性前置胎盘患者作为研究对象,根据球囊阻断的时机分组,其中52例于剖宫产术中切开子宫肌层的同时行球囊阻断(观察组),40例在胎儿娩出后行球囊阻断(对照组)。比较两组患者的手术相关指标(手术时间、术中出血量、术中红细胞悬浊液输入量、子宫切除率),新生儿预后(1 min Apgar评分、5 min Apgar评分),术后恢复情况(产后出血发生率、转ICU率、术后住院时间),以及并发症发生情况。结果观察组患者的手术时间、术中出血量、术中输入红细胞悬浊液量分别为(97.35±14.18)min、(746.73±354.68)mL、(1.73±1.52)U,少于对照组的(118.52±21.63)min、(925.86±407.53)mL、(3.18±1.26)U,差异均有统计学意义(P<0.05);观察组患者的子宫切除率为1.92%,与对照组的2.50%比较差异无统计学意义(P>0.05);观察组新生儿娩出1 min Apgar评分、5 min Apgar评分分别为(9.51±1.46)分、(9.44±1.32)分,对照组分别为(9.92±0.53)分、(9.83±0.75)分,两组比较差异均无统计学意义(P>0.05);观察组和对照组患者术后住院时间分别为(5.35±1.42)d、(5.82±1.79)d,差异无统计学意义(P>0.05);观察组产后出血发生率、转ICU率分别为7.69%、5.77%,明显低于对照组的22.50%、20.00%,差异均有统计学意义(P<0.05);观察组患者术后并发症发生率为3.85%,与对照组的2.50%比较差异无统计学意义(P>0.05)。结论凶险性前置胎盘剖宫产术中切开子宫肌层同时行球囊阻断,与胎儿娩出后实施阻断比较,更有利于控制术中、术后出血,且不会增加新生儿窒息风险。Objective To explore the effects of the timing of abdominal aortic balloon occlusion on hemorrhage and hysterectomy rate during cesarean section of dangerous placenta previa.Methods Ninety-two patients with dangerous placenta previa treated in Department of Obstetrics,the Third People's Hospital of Mianyang from January 2017 to October 2019 were selected as the research subjects,and they were grouped according to the timing of balloon occlusion:52 cases underwent abdominal aortic balloon occlusion at the same time of myometrial incision during cesarean section(observation group)and 40 cases underwent balloon occlusion after fetal delivery(control group).The surgical-related indexes(surgical time,intraoperative blood loss,intraoperative input of red blood cell suspension,hysterectomy rate),neonatal prognosis(1 min Apgar score,5 min Apgar score),postoperative recovery(incidence rate of postpartum hemorrhage,ICU conversion rate,postoperative hospital stay),and occurrence of postoperative complications were compared between the two groups.Results The surgical time,intraoperative blood loss,and intraoperative input of red blood cell suspension in the observation group were smaller than those in control group(all P<0.05):(97.35±14.18)min vs(118.52±21.63)min,(746.73±354.68)mL vs(925.86±407.53)mL,(1.73±1.52)U vs(3.18±1.26)U.There was no significant differences in the hysterectomy rate between the observation group and control group:1.92%vs 2.50%,P>0.05.There were no significant differences in the 1 min Apgar scores and 5 min Apgar scores of the newborns between the two groups(P>0.05):(9.51±1.46)points vs(9.92±0.53)points,(9.44±1.32)points vs(9.83±0.75)points.There was no significant difference in postoperative length of hospital stay between the two groups(P>0.05):(5.35±1.42)d vs(5.82±1.79)d,and the incidence rate of postpartum hemorrhage and ICU conversion rate in observation group were significantly lower than those in the control group(all P<0.05):7.69%vs 22.50%,5.77%vs 20.00%.There was no significant diff

关 键 词：腹主动脉球囊阻断 时机 凶险性前置胎盘 剖宫产 出血 子宫切除率 

分 类 号：R714.56[医药卫生—妇产科学]