妊娠中期胎盘前置子宫动脉栓塞术联合依沙吖啶、米非司酮引产效果  

Effect of uterine artery embolization combined with ethacridine and mifepristone used for termination of the second trimester of pregnancy in the women with placenta previa

作　　者：白静 向睿 李毅 彭菲 蒲丽 BAI Jing;XIANG Rui;LI Yi;PENG Fei;PU Li(West China Guang'an Hospital of Sichuan University(Guang'an People's Hospital),Sichuan Province,638000;The Second Affiliated Hospital of Chengdu Medical College,416 Hospital of Nuclear Industry,Chengdu,Sichuan Province)

机构地区：[1]四川大学华西广安医院(广安市人民医院),638000 [2]成都医学院第二附属医院,核工业四一六医院

出　　处：《中国计划生育学杂志》2023年第9期2025-2029,共5页Chinese Journal of Family Planning

基　　金：四川省卫生健康科研课题普及项目(19PJ211)。

摘　　要：目的:分析子宫动脉栓塞术(UA)联合依沙吖啶、米非司酮引产对孕中期胎盘前置状态患者预后的影响。方法:回顾性分析2017年1月-2022年1月在本院引产的中期妊娠瘢痕子宫胎盘前置状态患者临床资料,经一般资料匹配后,以行米非司酮+依沙吖啶引产70例为对照组,行米非司酮+依沙吖啶+UV引产70例为观察组。比较两组引产情况(引产时间、引产时出血量、输血情况、住院时间、住院费用),引产后月经恢复情况(月经复潮时间、月经周期、经期、月经量),月经恢复后第1个月经周期激素水平[黄体生成素(LH)、雌二醇(E_(2))、卵泡刺激素(FSH)],比较引产前后2组凝血指标[凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)],统计两组引产不良事件(软产道裂伤、胎盘残留、产褥期感染、发热、中转剖宫取胎、子宫切除)发生率。结果:观察组引产时间(26.5±7.9h)、引产时出血量(314.5±67.5ml)、输血比例(4.3%)、住院时间(5.1±1.1d)均少于对照组(29.6±7.9h、359.6±85.3ml、15.7%、6.2±1.2d),住院费用(10369±547元)高于对照组(5042±280元)(均P<0.05)。两组月经复潮时间、月经周期、经期及月经量比较无差异(P>0.05)。月经恢复后第1个月经周期结束时观察组LH(6.57±1.32 U/L)、FSH(7.23±1.44U/L)低于对照组(7.06±1.64U/L、7.92±1.51U/L),E_(2)(134.66±7.79pg/ml)高于对照组(130.53±6.62pg/ml);引产后24h,两组PT、APTT、FIB水平均高于引产前,D-D水平低于引产前,且观察组PT、APTT、FIB(13.60±1.59s、26.66±1.43s、3.78±0.41g/L)高于对照组(12.71±1.23s、25.16±1.23s、3.35±0.36g/L),DD(2.31±0.34mg/L)低于对照组(3.25±0.51mg/L),引产不良事件总发生率(11.4%)低于对照组(42.9%)(均P<0.05)。结论:米非司酮+依沙吖啶+UA在瘢痕子宫合并胎盘前置状态患者引产临床效果更优,且安全可靠。Objective:To analyze the effects of uterine artery embolization(UA)combined with ethacridine and mifepristone used for induced labor of pregnant women with placenta previa during the second trimester of pregnancy on their prognosis.Methods:The clinical data of pregnant women with scarred uterus and placenta previa during the second trimester of pregnancy who had been induced labor from January 2017to January 2022were analyzed retrospectively.Based on the matching by the general data,these women were divided 70cases with ethacridine combined with mifepristone for induced labor in control group and 70cases with UV combined with ethacridine and mifepristone for induced labor in observation group.The situations of labor induction,such as the time of labor induction,the blood loss during labor induction,the blood transfusion,the hospitalization time,and the hospitalization cost,the menstrual recovery situations after labor induction,such as the time of menstruation recovery,the menstrual cycle,the menstrual period,and the menstrual blood volume,and the levels of sex hormones,such as luteinizing hormone(LH),estradiol(E2),and follicle-stimulating hormone(FSH)of the women were compared between the two groups.The values of the coagulation indicators,such as prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and D-dimer(D-D)of the women before and after induced labor were compared between the two groups.The incidences of adverse events of induced labor,such as soft birth canal laceration,residual placenta,puerperal infection,fever,transition to cesarean section,and hysterectomy of the women in the two groups were statistically analyzed.Results:The duration of labor induction(26.5±7.9h),the blood loss during induced labor(314.5±67.5ml),the rate of blood transfusion(4.3%),and the hospital stay(5.1±1.1d)of the women in the observation group were all significantly lower than those(29.6±7.9h,359.6±85.3ml,15.7%,and 6.2±1.2d)of the women in the control group.The hospitalization cost(10369±547Y

关 键 词：中期妊娠引产 瘢痕子宫 胎盘前置 不同引产方案 临床结局 

分 类 号：R719.3[医药卫生—妇产科学]