摘要
目的 探讨腹主动脉球囊阻断术在伴穿透性凶险性前置胎盘剖宫产中的应用效果及对母婴结局的影响.方法 回顾性选取2020年10月至2022年10月唐山市妇幼保健院收治的伴穿透性凶险性胎盘前置产妇58例,根据治疗手段不同分为两组:观察组(n=20)和对照组(n=38).观察组产妇给予腹主动脉球囊阻断术治疗,对照组产妇给予常规剖宫产术治疗.比较两组产妇手术指标(术中出血量、术中输红细胞量、新生儿Apgar评分、手术时间、辐射剂量、住院时间、恶露延续时间、月经恢复时间)、凝血指标[凝血因子Ⅸ、凝血因子Ⅷ、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)]、心肌生化指标[肌酸激酶(CK)、磷酸肌酸激酶(CK-MB)、乳酸脱氢酶(LDH)]、妊娠结局(术后产妇转ICU发生率、子宫摘除率、并发症发生率)、新生儿结局(胎儿生命体征异常、新生儿窒息、胎儿窘迫及新生儿肺炎发生率).结果 观察组产妇术中出血量、术中输红细胞量、手术时间均低于对照组,新生儿Apgar评分高于对照组,差异均有统计学意义(P＜0.05).观察组产妇辐射剂量、住院时间均低于对照组,差异均有统计学意义(P＜0.05);两组产妇恶露延续时间、月经恢复时间比较,差异均无统计学意义(P＞0.05).术后24 h,两组产妇凝血因子Ⅸ、凝血因子Ⅷ及APTT均高于术前,FIB均低于术前,差异均有统计学意义(P＜0.05).术后24 h,两组CK低于术前,CK-MB、LDH均高于术前,差异均有统计学意义(P＜0.05).观察组产妇转ICU发生率、子宫摘除率、术后并发症发生率分别为5.00％、0、15.00％,均显著低于对照组(23.68％、13.16％、44.74％),差异均有统计学意义(P＜0.05).观察组产后胎儿生命体征异常、新生儿窒息、胎儿窘迫及新生儿肺炎发生率分别为5.00％、0、10.00％、5.00％,均明显低于对照组(10.53％、31.58％、23.68％、21.05％),差异均有统计学意义(P＜0.05).结论 给予伴穿透性凶险性前置胎盘产妇腹主动脉球囊阻断术,可有效降低手术出血量及术后的血液流失,改善产妇及新生儿的结局,明显降低术后不良反应的发生率.
Abstract
Objective To investigate the application effect of abdominal aortic balloon occlusion in cesarean section with penetrating and dangerous placenta previa and its impact on maternal and infant outcomes.Methods Fifty-eight patients with dangerous placenta previa admit-ted to Tangshan Maternal and Child Health Hospital from October 2020 to October 2022 were retrospectively selected and divided into the observa-tion group(n=20)and the control group(n=38)according to different treatment methods.Patients in the observation group were treated with abdominal aortic balloon occlusion,while patients in the control group were treated with conventional cesarean section.The surgical indicators(in-traoperative blood loss,intraoperative red blood cell transfusion volume,neonatal Apgar score,operation time,radiation dose,hospitalization time,lochia duration,menstrual recovery time),and coagulation indicators[coagulation factor Ⅸ,coagulation factor Ⅷ,activated partial pro-thrombin time(APTT),fibrinogen(FIB)],myocardial biochemical indicators[creative kinase(CK),creatine kinase MB(CK-MB),lactic dehydrogenase(LDH)],pregnancy outcomes(postoperative incidence of maternal transfer to ICU,complication rate,uterine removal rate),neo-natal indicators(abnormal fetal vital signs,fetal asphyxia,fetal distress and neonatal pneumonia incidence)were compared.Results The intrao-perative bleeding volume,intraoperative red blood cell transfusion volume,and operation time of the observation group were significantly lower than those of the control group,and the Apgar score of newborns was higher than that of the control group,and the differences were statistically signifi-cant(P＜0.05).The radiation dose and hospitalization time of the observation group were lower than those of the control group,and the differ-ences were statistically significant(P＜0.05).There were no statistically significant differences in the duration of lochia and menstrual recovery time between two groups(P＞0.05).At 24 h after operation,the coagulation factor Ⅸ,coagulation factor Ⅷ,and APTT of the two groups were higher than before surgery,and FIB was lower than before surgery,there were statistically significant differences in coagulation indicators between the two groups(P＜0.05).At 24 h after operation,the CK levels in two groups were lower than those before surgery,while CK-MB and LDH were higher than those before surgery,there were statistically significant differences in myocardial biochemical indicators between the two groups(P＜0.05).The incidence of ICU conversion,hysterectomy,and postoperative complications in the observation group were 5.00％,0％,and 15.00％,respectively,which were significantly lower than those in the control group(23.68％,13.16％,and 44.74％),and the differences were statistically significant(P＜0.05).The incidence rates of abnormal fetal vital signs,neonatal asphyxia,fetal distress,and neonatal pneu-monia in the observation group were 5.00％,0％,10.00％,and 5.00％,respectively,which were significantly lower than those in the control group(10.53％,31.58％,23.68％,and 21.05％),and the differences were statistically significant(P＜0.05).Conclusion Giving ab-dominal aortic balloon blockade in patients with penetrating and dangerous placenta previa can effectively reduce the amount of surgical bleeding and postoperative blood loss,improve the outcome of maternal and neonatal patients,and greatly reduce the occurrence of postoperative adverse reactions.
基金项目
河北省医学科学研究课题(2020)(20201488)
维普
万方数据