完全性前置胎盘患者剖宫产术后子宫恢复情况的比较  

Comparison of uterine recovery after caesarean section in patients with complete placenta previa

作　　者：赖少阳 赵捷 于威威 许培群 张雪芹 Lai Shaoyang;Zhao Jie;Yu Weiwei;Xv Peiqun;Zhang Xueqin(Department of Obstetrics,Women and Children's Hospital Affiliated to Xiamen University,Xiamen Fujian,361000,China;Reproductive Medicine Center in Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing,100191,China)

机构地区：[1]厦门大学附属妇女儿童医院产科,福建厦门361000 [2]北京大学第三医院妇产科生殖医学中心,北京100191

出　　处：《中外女性健康研究》2024年第10期8-13,共6页Women＇s Health Research

基　　金：厦门市医疗卫生指导性项目;福建省自然科学基金项目(面上),项目编号:3502Z20209199;2023J011613。

摘　　要：目的:本回顾性研究旨在探讨完全性前置胎盘(CPP)患者剖宫产术后子宫的恢复情况,并探讨剖宫产术中不同止血方式对剖宫产术后子宫恢复的影响。方法:对2020年7月至2022年12月在厦门大学附属妇女儿童医院行剖宫产术的169例患者的临床资料进行回顾性分析,其中包括89例CPP组和80例非前置胎盘患者(非CPP)组,比较术后子宫内膜厚度(EN)、月经恢复和子宫动脉血流的变化,并且比较不同止血方式对其影响。结果:与非CPP组相比,CPP组的估计失血量(EBL)更多(950.337±109.901 vs 484.750±175.290,P<0.001),月经恢复延迟(6.985±2.617 vs 5.433±4.083,P<0.001),EN减少(0.441±0.116 vs 0.501±0.120,P=0.001),术后第42天的子宫阻力指数(RI)更低(0.843±0.033 vs 0.858±0.031,P=0.003)。两组产后月经周期变化、搏动指数(PI)和子宫动脉收缩舒张比(S/D)无统计学意义(均P>0.05)。亚组分析显示,CPP组中不同止血方式对月经恢复、EN和第42天RI指数影响差异无明显统计学意义(均P>0.05)。结论:CPP患者剖宫产术后月经恢复、EN和第42天血供可能受到影响。CPP组术后患者月经恢复时间较长,EN较薄,第42天RI指数较低。而剖宫产术中不同止血方法对术后子宫功能恢复的影响无明显统计学意义。Objective:The retrospective study was designed to explore the recovery of uterine function in patients with complete placenta previa after caesarean delivery(CD).Methods:89 complete placenta previa patients(CPP)and 80 patients without CPP(non-PP)were included in this study from July 2020 to December 2022.Then the clinical data including the changes in menstruation resumption,the endometrial thickness and uterine vascular supply as measured by uterine resistance index(RI),pulsatility index(PI)and systolic/diastolic ratio(S/D)at 42nd days were collected and compared.Results:Group CPP had much more estimated blood loss(950.337±109.901 vs 484.750±175.290,P<0.001),a delayed resumption menstruation(6.985±2.617 vs 5.433±4.083,P<0.001),a reduced endometrial thickness(0.441±0.116 vs 0.501±0.120,P=0.001),and a lower uterine resistance index(RI)at 42nd days after CD(0.843±0.033 vs 0.858±0.031,P=0.003)when compared with group non-PP.There were no statistically significant differences between the 2 groups in postpartum menstrual cycle changes,and PI index and S/D ratio(all P>0.05).Subgroup analysis between group CPP with different hemostatic methods also showed that there were no statistically significant differences in the menstruation resumption,endometrial thickness,and RI index at 42nd days after CD(all P>0.05).Conclusion:The menstruation resumption,the endometrial thickness and blood supply at 42nd days maybe affected after CD in patients with CPP.The time to menstrual recovery was longer,the endometrial thickness was thinner,and RI index at 42nd days was lower than that of non-PP group.While there were no statistically significant differences in the impact of different hemostatic methods used during CD on the recovery of uterine function.

关 键 词：完全性前置胎盘 剖宫产 月经恢复 子宫内膜厚度 子宫动脉血 

分 类 号：R719.8[医药卫生—妇产科学]