动脉序贯介入治疗对凶险型前置胎盘的疗效评价

发布时间：2018-11-11 13:48

【摘要】：目的:评价动脉序贯介入治疗(髂内动脉置管+封堵/子宫动脉或髂内动脉栓塞)对凶险型前置胎盘(PPP)出血的治疗效果。方法:选取在我院诊治的有胎盘植入高危因素的69例PPP患者,其中29例给予传统的治疗方法(对照组),40例给予动脉序贯介入治疗(观察组)。比较分析两组患者的术中出血量、输红悬量、子宫切除率、剖宫产手术时间、剖宫产术后24h出血量、术后住院时间、术后抗生素使用时间及并发症(疼痛、发热、感染及其它并发症)发生率。结果:观察组与对照组的术中出血量[(868.5±549.77)ml vs(1506.90±1417.39)ml]、输红悬量[(1.50±1.40)U vs(2.72±2.00)U]、子宫切除率(2.50%vs 17.24%)、剖宫产手术时间[(58.86±20.33)min vs(70.83±29.26)min]、术后疼痛发生率(81.25%vs 48.28%)、其它并发症发生率(0.00%vs 10.35%)比较,差异均有统计学意义(P0.05)。两组的剖宫产术后24h出血量、术后住院时间、术后抗生素使用时间、疼痛VAS评分、术后发热发生率、术后感染发生率比较,差异均无统计学意义(P0.05)。两组产妇(子宫切除者除外)均于停止哺乳后1~3月月经恢复情况正常;42天常规新生儿体检,血象、肝功能及神经系统检查无明显异常、新生儿均无血液系统疾病。结论:动脉序贯介入治疗PPP有效、可行,且对母婴安全。
[Abstract]:Objective: to evaluate the efficacy of sequential arterial interventional therapy (internal iliac artery closure / uterine artery or internal iliac artery embolization) in the treatment of severe placenta previa (PPP) hemorrhage. Methods: 69 PPP patients with high risk factors of placenta implantation were selected, 29 of them were treated with traditional treatment (control group) and 40 with sequential arterial intervention (observation group). The amount of intraoperative bleeding, the amount of red suspension, the rate of hysterectomy, the time of cesarean section, the amount of blood lost 24 hours after cesarean section, the time of hospitalization, the time of using antibiotics and complications (pain, fever) were compared and analyzed. Incidence of infection and other complications. Results: the intraoperative bleeding volume [(868.5 卤549.77) ml vs (1506.90 卤1417.39) ml], red suspension volume [(1.50 卤1.40) U vs (2.72 卤2.00) U] and hysterectomy rate (2.50%vs 17.24%) were observed in the observation group and the control group. The duration of cesarean section [(58.86 卤20.33) min vs (70.83 卤29.26) min], the incidence of postoperative pain (81.25%vs 48.28%) and other complications (0.00%vs 10.35%) were compared. The difference was statistically significant (P0.05). There was no significant difference between the two groups in the amount of bleeding 24 hours after cesarean section, postoperative hospitalization time, postoperative antibiotic use time, pain VAS score, postoperative fever rate and postoperative infection rate (P0.05). The recovery of menstruation in both groups (except hysterectomy) was normal from 1 to 3 months after the termination of lactation, and there was no obvious abnormality in routine neonatal physical examination, blood picture, liver function and nervous system examination, and there was no hematological disease in the newborns. Conclusion: sequential arterial intervention for PPP is effective, feasible and safe for mother and child.
【作者单位】：成都市妇女儿童中心医院产科;成都市妇女儿童中心医院放射科;
【基金】：成都市卫生局课题(No:2014061) 国家科技支撑计划课题(No:2014BAI05B00) 妊娠合并危急重症救治技术及防控模式研究(No:2014BAI05B05)
【分类号】：R714.5

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