前置胎盘致围产期子宫切除患者的临床分析

发布时间：2019-03-17 11:51

【摘要】：目的探讨前置胎盘患者并发产后出血后行围产期子宫切除术的高危因素、手术时机及术中处理,并探讨母婴结局。方法回顾性分析我院产科2009年1月至2013年12月期间收治的1 163例前置胎盘患者临床资料。结果 (1)前置胎盘发生率为2.9%(1 163/40 804);同期围产期子宫切除患者89例,因前置胎盘而行子宫切除患者39例(43.8%,39/89);(2)前置胎盘患者行子宫切除术的各种高危因素进行比较,其中高龄、经产妇、剖宫产史、中央性前置胎盘、胎盘植入以及凶险性前置胎盘等因素的差异有统计学意义(P0.01);(3)因前置胎盘而行子宫切除患者术中总出血量与未行子宫切除患者的出血量相比,差异有统计学意义(P0.01)。(4)39例切除子宫患者术后有21例(21/39,53.8%)转入ICU病房,活产35例(35/39,89.7%),共有新生儿37例(其中双胎2例),12例(12/37,32.4%)转入新生儿科继续治疗,死亡1例,死亡率2.7%(1/37)。结论高龄、经产妇、剖宫产史、中央性前置胎盘、胎盘植入以及凶险性前置胎盘等因素是前置胎盘患者行子宫切除术的高危因素;因前置胎盘而行子宫切除的患者占围产期子宫切除患者的比例较大。重视术前风险评估,提高围手术期处理水平,对减少术中出血、改善母儿预后至关重要。
[Abstract]:Objective to investigate the high risk factors of perinatal hysterectomy in patients with placenta previa complicated with postpartum hemorrhage, and to explore the outcome of mother and infant. Methods the clinical data of 1 163 cases of placenta previa admitted in our obstetrics department from January 2009 to December 2013 were retrospectively analyzed. Results (1) the incidence of placenta previa was 2.9% (1 163 脳 40 804), 89 cases of perinatal hysterectomy and 39 cases of placenta previa hysterectomy (43.8%, 39 / 89). (2) the risk factors of hysterectomy in patients with placenta previa were compared, including elderly, transparturient, cesarean section, central placenta previa. There was significant difference in placental accretion and dangerous placenta previa (P0.01). (3) the total amount of bleeding in patients undergoing hysterectomy due to placenta previa was higher than that in patients without hysterectomy. The difference was statistically significant (P0.01). (4). There were 21 cases (21 / 39, 53.8%) transferred to ICU ward after hysterectomy in 39 cases, 35 live births (35 / 39, 89.7%), 37 newborns (2 twins among them), and 35 live births (35 / 39, 89.7%), and 21 cases (21 / 39, 53.8%) were transferred to ICU ward after hysterectomy. 12 cases (12 / 37, 32.4%) were transferred to neonatal pediatrics for further treatment, one case died and the mortality rate was 2.7% (1 / 37). Conclusion the high risk factors of hysterectomy are elderly, transparturient, cesarean section, central placenta previa, placental accretion and dangerous placenta previa. The proportion of patients undergoing hysterectomy due to placenta previa is higher than that of perinatal hysterectomy. It is very important to pay attention to preoperative risk assessment and improve perioperative management level for reducing intraoperative bleeding and improving maternal and fetal prognosis.
【作者单位】：中国医科大学附属盛京医院妇产科;
【基金】：国家自然科学基金(81300492)
【分类号】：R714.7

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