基于超声征象和临床高危因素的风险模型预测凶险性前置胎盘术中严重出血的临床价值  

Clinical value of a risk model based on ultrasonic signs and clinical risk factors in predicting severe intraoperative hemorrhage in patients with pernicious placenta previa

作　　者：崔静静 薛晶晶 王莉[2] 葛辉玉 CUI Jingjing;XUE Jingjing;WANG Li;GE Huiyu(Department of Ultrasound,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院超声科,北京市100020 [2]首都医科大学附属北京妇产医院北京妇幼保健院超声科

出　　处：《临床超声医学杂志》2024年第10期813-818,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的基于超声征象和临床高危因素构建风险模型,探讨其预测凶险性前置胎盘患者术中严重出血的临床价值。方法选取凶险性前置胎盘患者80例,根据术中出血量分为轻型出血组(出血量<1000 ml)27例和重型出血组(出血量≥1000 ml)53例,比较两组超声征象、临床高危因素的差异。采用二元Logistic回归分析筛选预测凶险性前置胎盘患者术中严重出血的独立危险因素并构建风险模型;绘制受试者工作特征曲线分析其预测凶险性前置胎盘患者术中严重出血的诊断效能。结果轻型出血组中,无胎盘植入性疾病12例(44.44%),胎盘粘连13例(48.15%),胎盘植入2例(7.41%);重型出血组中,胎盘粘连11例(20.76%),胎盘植入24例(45.28%),胎盘穿透18例(33.96%)。共7例行子宫切除术,均为重型出血组患者。轻型出血组与重型出血组剖宫产次数、胎盘后间隙、胎盘陷窝、子宫膀胱交界面血流、膀胱线及宫颈受累情况比较,差异均有统计学意义(均P<0.05)。二元Logistic回归分析显示,剖宫产次数和子宫膀胱交界面血流均为预测凶险性前置胎盘患者术中严重出血的独立危险因素(OR=10.560、15.831,均P<0.05);由此构建的风险模型预测凶险性前置胎盘患者术中严重出血的曲线下面积为0.805,其与子宫膀胱交界面血流的曲线下面积(0.768)均高于剖宫产次数的曲线下面积(0.632),差异均有统计学意义(均P<0.05)。结论基于剖宫产次数和子宫膀胱交界面血流构建的风险模型在预测凶险性前置胎盘患者术中严重出血中有较好的临床价值。Objective To construct a risk model based on ultrasonic signs and clinical high-risk factors,and to explore its clinical value in predicting severe intraoperative hemorrhage in patients with pernicious placenta previa.Methods A total of 80 patients with pernicious placenta previa were selected and divided into a mild hemorrhage group(hemorrhage volume<1000 ml,27 cases)and a severe hemorrhage group(hemorrhage volume≥1000 ml,53 cases)according to the intraoperative hemorrhage volume.The differences in clinical risk factors and ultrasonic signs between the two groups were compared.Binary Logistic regression analysis was used to screen the independent risk factors for severe intraoperative hemorrhage in patients with pernicious placenta previa,and a risk model was constructed.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of the model in predicting severe intraoperative hemorrhage in patients with pernicious placenta previa.Results In the mild hemorrhage group,12 cases(44.44%)without placenta accreta spectrum disorders,13 cases(48.15%)with placental adhesion,and 2 cases(7.41%)with placenta accreta.In the severe hemorrhage group,11 cases(20.76%)with placental adhesion,24 cases(45.28%)with placenta accreta,and 18 cases(33.96%)with placenta percreta.A total of 7 cases underwent hysterectomy,all of whom were in the severe hemorrhage group.There were significant differences in cesarean section times,disappearance of retroplacental space,placental lacunae,blood flow at uterovesical junction,interruption of bladder line and cervical involvement between the mild hemorrhage group and the severe hemorrhage group(all P<0.05).Binary Logistic regression analysis showed that the cesarean section times and blood flow at the uterovesical junction were independent risk factors for severe intraoperative hemorrhage in patients with pernicious placenta previa(OR=10.560,15.831,both P<0.05).The area under the curve of constructed risk model and blood flow at uterovesical junction for predicting

关 键 词：超声检查 胎盘植入性疾病 凶险性前置胎盘 子宫切除 严重出血 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.2[医药卫生—诊断学]