凶险型前置胎盘并胎盘植入患者介入置管栓塞对凝血系统和母婴结局的影响  

Effects of interventional catheterization and embolization on the coagulation system and maternal and infant outcomes in patients with pernicious placenta previa and placenta accreta

作　　者：孙鹏程 张鑫[2] 郭亚潘 李波[1] 倪才方[1] SUN Pengcheng;ZHANG Xin;GUO Yapan;LI Bo;NI Caifang(Department of Intervention,the First Affiliated Hospital of Suzhou University,Suzhou Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院介入科,江苏苏州215006 [2]苏州市相城人民医院介入科,江苏苏州215131

出　　处：《中国急救复苏与灾害医学杂志》2025年第4期512-515,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省自然科学基金(BK20221235)。

摘　　要：目的 探讨凶险型前置胎盘并胎盘植入患者分娩术前介入置管术中栓塞靶血管对围手术期凝血系统和母婴结局的影响。方法 选择2019年3月—2023年9月就诊于苏州大学附属第一医院的凶险型前置胎盘并胎盘植入患者106例,以随机数字表法分为对照组、研究组,各53例。两组均接受剖宫产术,对照组术前未介入置管栓塞,研究组术前介入置管并且术中栓塞子宫动脉,子宫动脉超选不成功者避开臀上动脉栓塞髂内动脉。对比两组围手术期指标、凝血系统、产后并发症、新生儿结局以及产妇产后月经及恶露情况。结果 研究组的手术时间与住院时间比对照组短(t=17.891、11.543,均P<0.001),研究组的术后24 h出血量与术中出血量比对照组低(t=27.146、46.555,均P<0.001)。术后24 h,两组的凝血酶时间(TT)、凝血酶原时间(PT)水平比较,差异无统计学意义(均P>0.05);研究组术后24 h的纤维蛋白原(Fig)、D-二聚体(D-D)水平高于对照组(t=15.875、29.187,均P<0.05)。研究组产后出血>1 000 mL、产褥期感染、弥漫性血管内凝血发生率均比对照组低(χ^(2)=5.267、5.950、4.867,均P<0.05),两组子宫切除、失血性休克发生率对比,差异无统计学意义(均P>0.05)。两组新生儿窒息、早产、出生1 min Apgar评分、新生儿死亡发生率对比,差异无统计学意义(均P>0.05);研究组的新生儿出生体质量高于对照组(χ^(2)=2.451,P<0.05)。两组第1次月经恢复时间、第1次月经量、恶露持续时间、产后月经周期、恢复正常月经量所需次数对比,差异无统计学意义(均P>0.05)。结论 介入置管栓塞可维持凶险型前置胎盘并胎盘植入患者分娩围手术期凝血系统稳定,减少手术创伤,改善母婴结局。Objective To study the effects of interventional catheterization and embolization on the coagulation system in patients with pernicious placenta previa and placenta accrete.Methods A total of 106 patients with pernicious placenta previa and placenta accrete who admitted to the First Affiliated Hospital of Suzhou University from March2019 to September 2023 were conducted on this study.All patients were randomly divided into a control group(53cases)and a study group(53 cases).Both groups underwent cesarean section,with the preoperative interventional catheterization and intraoperative embolization of the uterine artery on study group.The perioperative indexes,coagulation system,postpartum complications,neonatal outcomes and the recovery of menstruation and lochia were compared between two groups.Results The operation time and hospitalization time were shorter in the study group than in the control group(t=17.891,11.543,allP<0.001),the 24 hours postoperative bleeding volume in the study group was lower than that in the control group(t=27.146,46.555,allP<0.001).At 24 hours after the surgery,comparison of thrombin time +(TT) and prothrombin time(PT) levels in the two groups,there was no statistically significant difference(allP>0.05);The levels of fibrinogen(Fig) and D-dimer(D-D) at 24 hours were higher than those in the control group(t=15.875,29.187,allP<0.05).Postpartum hemorrhage> 1 000 mL,puerperium infection,and diffuse intravascular coagulation were all at lower rates than those in the control group(χ^(2)=5.267,5.950,4.867,allP<0.05),comparison of the incidence of hysterectomy and hemorrhagic shock in the two groups,there was no statistically significant difference(allP>0.05).Comparison of asphyxia,prebirth,birth 1 min Apgar score and neonatal death incidence between two groups,there was no statistically significant difference(allP>0.05);the birth mass of the study group was higher than the control group(χ^(2)=2.451,P<0.05).The two groups compared the first menstrual recovery time,the first menstrual volume,lo

关 键 词：凶险型前置胎盘 胎盘植入 介入置管 凝血系统 母婴结局 围手术期指标 甲胎蛋白 

分 类 号：R714.4[医药卫生—妇产科学]