止血囊与纱条填塞分别联合腹主动脉临时阻断术应用于伴胎盘植入孕妇剖宫产术中止血的价值  

Value of hemostatic sac or gauze packing combined with temporary abdominal aortic occlusion on hemostasis of pregnant women with placenta accreta during cesarean section

作　　者：徐亚[1] 何静媛[1] XU Ya;HE Jing-yuan(Department of Obstetrics,Deyang People s Hospital,Deyang 618000,Sichuan,China)

机构地区：[1]德阳市人民医院产科,四川德阳618000

出　　处：《川北医学院学报》2024年第1期26-29,共4页Journal of North Sichuan Medical College

基　　金：四川省科技厅科研项目(2023JDKP0041)。

摘　　要：目的:探讨止血囊与纱条填塞分别联合腹主动脉临时阻断术用于伴胎盘植入孕妇剖宫产术中止血的价值。方法:回顾性分析伴胎盘植入且有意愿保留子宫的185例孕妇的临床资料,按照手术止血方法不同分为止血囊组(n=92)和纱条组(n=93)。对比两组手术相关指标(腹主动脉临时阻断时间、止血成功率、填塞物脱落率、填塞时间)、围术期出血量、纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT),统计并发症总发生率。结果:止血囊组腹主动脉临时阻断时间和填塞时间短于纱条组(P<0.05),术中及术后2、24 h出血量均少于纱条组(P<0.05),止血成功率高于纱条组(P<0.05),填塞物脱落率和术后并发症总发生率均低于纱条组(P<0.05),术后24 h FIB高于纱条组(P<0.05),PT和APTT低于纱条组(P<0.05)。结论:腹主动脉临时阻断术联合止血囊以及纱条均可有效改善伴胎盘植入剖宫产术中出血,止血囊成功率和安全性更高。Objective:To explore the value of hemostatic sac or gauze packing combined with temporary abdominal aortic occlusion on hemostasis during cesarean section of pregnant women with placenta accreta.Methods:The clinical data of 185 pregnant women with placental accreta who were willing to preserve the uterus were retrospectively collected.According to different surgical methods of hemostasis,the pregnant women were divided into hemostatic sac group(n=92)and gauze group(n=93).The surgery-related indicators(temporary abdominal aortic occlusion time,success rate of hemostasis,packing off rate,packing time),perioperative blood loss,fibrinogen(FIB),prothrombin time(PT)and activated partial thromboplastin time(APTT)were compared between the two groups,and the total incidence rate of complications was statistically analyzed.Results:Compared with gauze group,the abdominal aorta temporary occlusion time and packing time were shorter,and the intraoperative blood loss,blood loss at 2,24 h after surgery were less,and the success rate of hemostasis was higher,while the packing off rate and incidence rate of postoperative complications were lower in hemostatic sac group(P<0.05).The FIB levels in hemostatic sac group was better than that in gauze group,and the PT and APTT were shorter than those in gauze group(P<0.05).Conclusion:For pregnant women with placenta accreta undergoing cesarean section,temporary abdominal aortic occlusion combined with hemostatic sac and gauze both can effectively improve the intraoperative blood loss,but hemostatic sac has higher success rate and safety.

关 键 词：胎盘植入 剖宫产 止血囊 纱条填塞 腹主动脉临时阻断术 术中止血 

分 类 号：R714.46[医药卫生—妇产科学] R719.8[医药卫生—临床医学]