双侧子宫动脉上行支结扎在中央性前置胎盘剖宫产术中大出血中的应用研究  

Application of Ligation of Bilateral Ascending Branches of Uterine Arteries in the Treatment of Massive Hemorrhage During Central Placenta Previa Cesarean Section

作　　者：袁亚楠[1] 徐毅[1] 王新荣 YUAN Yanan;XU Yi;WANG Xinrong(Department of Obstetrics and Gynecology,Zhengzhou Maternal and Child Health Hospital,Zhengzhou Obstetrics and Gynecology Hospital affiliated to Henan University),Zhengzhou Henan 450000,China)

机构地区：[1]郑州市妇幼保健院,河南大学附属郑州妇产医院产科,河南郑州450000

出　　处：《临床研究》2022年第12期12-15,共4页Clinical Research

摘　　要：目的分析前置胎盘(中央性)剖宫产患者术中大出血采用双侧子宫动脉上行支结扎术(BUAL)治疗取得的效果。方法回顾性分析2018年5月至2020年4月郑州市妇幼保健院收治的中央型前置胎盘且在剖宫产术中出现大出血的79例患者资料,以不同止血方式将其分为两组,即行常规止血方案(按摩子宫、肌层注射卡前列素氨丁三醇、使用溶入止血药的温生理盐水无菌纱布进行剥离面垫压等)+“8”字缝合止血的对照组40例,常规止血方案+“8”字缝合止血+BUAL止血的研究组39例。针对两组止血效果、输血率、子宫切除率,手术操作时间与失血量、术后出血量、恶露持续时间、月经恢复时间与住院时间,止血治疗前后凝血功能指标,止血治疗前与治疗3个月时卵巢功能指标及产后并发症情况进行比较。结果止血有效率比较中,研究组高于对照组,差异有统计学意义(P<0.05);输血率低于对照组,差异有统计学意义(P<0.05);子宫切除率的组间结果比较,差异无统计学意义(P>0.05)。研究组手术时间、术中失血量、术后24 h出血量均低于对照组,差异有统计学意义(P<0.01);两组恶露持续时间、月经恢复时间与住院时间的结果比较,差异无统计学意义(P>0.05)。治疗后,研究组凝血功能血酶原时间(PT)、纤维蛋白原(FIB)、部分凝血活酶时间(APTT)均低于对照组,差异有统计学意义(P<0.05)。治疗3个月时,研究组卵巢功能卵泡刺激素(FSH)、黄体生成素(LH)指标均低于对照组,雌二醇(E_(2))指标高于对照组,差异有统计学意义(P<0.05)。研究组产后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论前置胎盘(中央性)剖宫产术中大出血患者行BUAL手术可以达到理想的止血目的,且保障了患者的凝血功能,促进卵巢功能恢复,降低产后并发症概率,适于临床应用。Objective To analyze the effect of bilateral upstream branch ligation of uterine artery(BUAL)in the treatment of massive hemorrhage in patients with placenta previa(central)cesarean section.Methods The data of 79 patients with central placenta previa and massive hemorrhage during cesarean section admitted to Zhengzhou Maternal and Child Health Hospital from May 2018 to April 2020 were retrospectively analyzed,and they were divided into two groups by different hemostatic methods.40 cases in the control group received a conventional hemostatic program(uterus massage,intramural injection of carboprost tromethamine,surface compression with warm saline sterile gauze dissolved in hemostatic agent)+"8"suture for hemostasis,and 39 cases in the study group who received conventional hemostatic program+"8"suture for hemostasis+BUAL hemostasis.The hemostatic effect,blood transfusion rate,hysterectomy rate,operation time and blood loss,postoperative blood loss,lochia duration,menstrual recovery time and hospital stay,coagulation function indexes before and after hemostatic treatment,ovarian function indexes before hemostatic treatment and 3 months after treatment and postpartum complications were compared between the two groups.Results The hemostatic effective rate in the study group was higher than that in the control group,the difference was statistically significant(P<0.05).The blood transfusion rate was lower than the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the results of the hysterectomy rate between groups(P>0.05).The operation time,intraoperative blood loss and 24 h postoperative blood loss in the study group were lower than those in the control group,and the difference was statistically significant(P<0.01).There was no significant difference in lochia duration,menstrual recovery time,and hospital stay between the two groups(P>0.05).After treatment,the thrombin function prothrombin time(PT),fibrinogen(FIB),and activated partial thromboplastin time(AP

关 键 词：中央性前置胎盘 双侧子宫动脉上行支结扎术 剖宫产术 术中大出血 

分 类 号：R719.8[医药卫生—妇产科学]