凶险性前置胎盘127例临床分析

发布时间：2018-05-29 03:35

本文选题：凶险性前置胎盘 + 胎盘植入　；参考：《暨南大学学报(自然科学与医学版)》2015年04期

【摘要】：目的:探讨凶险性前置胎盘的围手术期的高危因素及应对策略.方法:对127例凶险性前置胎盘的病例产前出血、术中出血、围手术期出血、子宫切除率、及其他母儿严重并发症进行分析.根据前置胎盘类型分为:中央性前置胎盘组与部分行前置胎盘组.根据术中胎盘剥离情况分为:胎盘植入组、胎盘粘连组及正常剥离组.结果:(1)胎盘植入率:中央组为49.5%,明显高于部分组胎盘植入率23.1%(P0.05).(2)围手术期出血:中央组平均为1 800 m L,高于部分组平均1 128 m L(P0.01).胎盘植入组平均2 636 m L,胎盘粘连组平均1 342 m L,胎盘正常剥离组平均822 m L,各组间均有统计学差异(P0.01).(3)输血情况:胎盘植入组有98.2%患者术后接受输血治疗,平均输血量2 255 m L,胎盘粘连组有88.2%患者接受输血,平均1 267 m L,正常剥离组有53.7%患者接受输血,平均1 165 m L,胎盘植入组明显高于粘连组(P0.05)及正常剥离组(P0.01),而粘连组与正常剥离组比较无统计学差异(P0.05).(4)子宫切除情况:中央组为34.7%,高于部分组15.4%(P0.05).胎盘植入组为62.5%,明显高于胎盘粘连与正常联合组5.6%(P0.05).(5)预后:产妇有1例术中出现心脏骤停经抢救预后良好,1例新生儿畸形死亡,其余母儿预后均良好.结论:凶险性前置胎盘胎盘植入率高,合并中央性前置胎盘者,出血是最主要的风险,大量输血准备及果断行子宫切除术是手术成功的关键.
[Abstract]:Objective: to investigate the high risk factors and coping strategies of peri-operative period of dangerous placenta previa. Methods: antepartum hemorrhage, intraoperative hemorrhage, perioperative bleeding, hysterectomy rate, and other severe complications were analyzed in 127 cases of severe placenta previa. According to the type of placenta previa, the placenta previa group and placenta previa group were divided into central placenta group and partial placenta previa group. According to the condition of placental detachment during operation, the placenta accreta group, placental adhesion group and normal exfoliation group were divided into three groups. Results the rate of placenta accreta in the central group was 49.5, which was significantly higher than that in the group with partial placenta accreta (23.1g / kg). The mean rate of hemorrhage in the central group was 1 800 mL, which was higher than that in the central group (1 128 mL / L P 0.01). The average blood transfusion was 2 636 mL in the placenta accreta group, 1 342 mL in the placental adhesion group and 822 mL in the normal placental detachment group. There was significant difference in blood transfusion among the three groups. 98.2% of the patients in the placenta accreta group received blood transfusion after operation. The average volume of blood transfusion was 2 255 mL, 88. 2% of the patients in placental adhesion group received blood transfusion, the average was 1 267 mL, and 53.7% of patients in normal group received blood transfusion. The average value of hysterectomy in placenta accreta group was significantly higher than that in adherent group (P 0.05) and normal group (P 0.01), but there was no significant difference in hysterectomy between adhesive group and normal group. The prognosis of placenta accreta group was 62.5, which was significantly higher than that of placental adhesion group and normal group (P 0.05): one case of cardiac arrest had a good prognosis during the operation and one case of neonatal malformation died, and the other mothers and infants had a good prognosis. Conclusion: severe placenta previa has a high rate of placenta accreta. Hemorrhage is the most important risk in patients with central placenta previa. Massive blood transfusion preparation and hysterectomy are the key to success of the operation.
【作者单位】：暨南大学附属第二临床医学院;深圳市人民医院产科;
【基金】：深圳市科技创新计划资助项目(JCYJ20140416122812042)
【分类号】：R714.56

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