本文關(guān)鍵詞：剖宮產(chǎn)術(shù)后再次妊娠合并前置胎盤及植入中期引產(chǎn)方法的初探　出處：《山東大學》2017年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 氯化鉀 瘢痕子宮 胎盤前置狀態(tài) 胎盤植入 引產(chǎn)

【摘要】：研究目的:瘢痕子宮、胎盤前置狀態(tài)并胎盤植入中期終止妊娠既往多直接剖宮取胎,但術(shù)中大出血風險較高。有研究表明,完全性前置胎盤引產(chǎn)前先向胎兒心腔內(nèi)注射KCL能減少引產(chǎn)過程中出血量。因此,我們嘗試將KCL胎兒心腔內(nèi)注射應用在胎盤前置狀態(tài)及胎盤植入需中期引產(chǎn)的患者中,探討其是否能有效減少引產(chǎn)過程中出血量,同時探尋中期妊娠引產(chǎn)新方法。研究方法:選取山東大學齊魯醫(yī)院2012年3月-2017年2月期間,瘢痕子宮、胎盤前置狀態(tài)并胎盤植入中期妊娠引產(chǎn)患者共29例,入組標準:瘢痕子宮、本次妊娠孕周為14-27+6周、胎盤前置狀態(tài)并植入,自愿放棄本次妊娠。主要依據(jù)彩超或MRI表現(xiàn)診斷胎盤前置狀態(tài)并胎盤植入。自愿選擇引產(chǎn)前行KCL胎兒心內(nèi)注射14例為觀察組;直接剖宮取胎15例為對照組。觀察組先行KCL胎兒心內(nèi)注射,植入輕者可自行發(fā)動宮縮或給予米索前列醇引產(chǎn);植入程度深者復查彩超證實胎死宮內(nèi)后出院,門診定期復查胎盤血流及β-HCG水平,待胎盤血流明顯減少后再次入院行超聲引導下經(jīng)陰鉗夾術(shù)。對照組術(shù)前無特殊處理,直接行剖宮取胎術(shù)。觀察兩組患者臨床資料。數(shù)據(jù)采用SPSS23.0進行錄入與統(tǒng)計。計量資料符合正態(tài)分布、方差齊性者組間差異比較采用兩獨立樣本t檢驗,以X±S描述。非正態(tài)分布者、方差不齊者用非參數(shù)檢驗。計數(shù)資料采用卡方檢驗或Fisher精確檢驗法。P0.05認為差異有統(tǒng)計學意義。結(jié)果:1.一般情況:分別比較觀察組和對照組患者在年齡、孕次、既往剖宮產(chǎn)次數(shù)及流產(chǎn)次數(shù)等差異無統(tǒng)計學意義(P0.05)。2.兩組各結(jié)局指標對比:觀察組平均出血量(902.14±1060.3)ml,平均輸紅細胞量(3.89±3.28)U。對照組平均出血量(2546.7±1686.9)ml,平均輸紅細胞量(10.93±6.84)U。兩組間出血量及輸注紅細胞量比較差異有統(tǒng)計學意義。引產(chǎn)前先行KCL減胎術(shù)比起直接剖宮取胎,出血量及輸血量均明顯降低。兩組間住院費用差異無統(tǒng)計學意義(P0.05)。住院天數(shù)差異有統(tǒng)計學意義(P0.05),先行KCL減胎治療者住院天數(shù)長于直接剖宮取胎組。子宮切除:觀察組0例,對照組2例;轉(zhuǎn)ICU:觀察組0例,對照組1例。兩組子宮切除率、轉(zhuǎn)ICU率、無統(tǒng)計學差異。兩組均無嚴重感染及嚴重凝血功能障礙者。3.觀察組妊娠結(jié)局分為三種:KCL注射后經(jīng)陰分娩(n=5),KCL注射后行超聲引導下經(jīng)陰鉗夾術(shù)(n=4),KCL注射后剖宮取胎(n=5)。行組間比較,三組在年齡、孕周、既往孕產(chǎn)史、出血量、輸血量、住院天數(shù)方面差異均無統(tǒng)計學意義。KCL注射后經(jīng)陰分娩與KCL注射后剖宮取胎住院費用存在差異,P=0.015(P0.017),KCL注射后經(jīng)陰分娩比KCL注射后剖宮取胎住院費用少。植入程度淺的患者注射KCL后更易自動發(fā)動宮縮經(jīng)陰引產(chǎn),自注射KCL至經(jīng)陰分娩平均天數(shù)12天(2～21天)。穿透性胎盤植入自注射KCL至行超聲引導下經(jīng)陰鉗夾術(shù)平均108天(86～152天),β-HCG降至正常平均116.5天(89～134天)。4.KCL注射后剖宮取胎組與直接剖宮取胎組對比:兩組在年齡、孕周、出血量、輸血量、住院天數(shù)、住院費用方面差異無統(tǒng)計學意義。5.術(shù)后隨訪:大多數(shù)患者均于產(chǎn)后1～2個月月經(jīng)正常復潮。結(jié)論:1.剖宮產(chǎn)術(shù)后再次妊娠合并前置胎盤及植入患者中期妊娠引產(chǎn)前先行KCL胎兒心內(nèi)注射,待胎盤血流明顯減少后再經(jīng)陰引產(chǎn)是一種安全、經(jīng)濟的引產(chǎn)方案,可以有效避免再次開腹手術(shù)。2.氯化鉀胎兒心內(nèi)注射后死胎3-4個月并不會影響凝血功能。
[Abstract]:Objective: scar uterus, placenta previa and placenta implantation mid pregnancy termination were directly cesarean, but intraoperative hemorrhage risk is higher. Studies have shown that complete placenta previa before induction to fetal heart cavity injection of KCL can reduce the amount of bleeding during labor. Therefore, we try to use the KCL fetal heart in the application of cavity injection of placenta previa and placenta implantation for mid-term pregnancy patients, to investigate whether it can effectively reduce the amount of bleeding in the process of induced abortion, and to explore the new method of mid pregnancy abortion. Methods: from Qilu Hospital of Shandong University in March 2012 -2017 year in February period, scar uterus, placenta previa placenta implantation and pregnancy induced labor in patients with a total of 29 inclusioncriteria: Cases of uterine scar, the pregnancy 14-27+6 weeks of pregnancy, placenta previa and implantation, voluntarily give up this pregnancy. According to ultrasound or MRI The diagnosis of placenta previa and placenta implantation. Voluntary induced abortion KCL before fetal heart injection in 14 cases of the observation group; direct cesarean section of 15 cases as control group. The observation group received KCL fetal intracardiac injection, implantation of the light can be launched their own contractions or give misoprostol; implantation depth review of ultrasound confirmed intrauterine discharge fetal death, periodic review of outpatient service of placental blood flow and beta -HCG level, the placental blood flow was significantly reduced after readmission for ultrasound-guided transvaginal clipping. Control group without special treatment for caesarean operation. Two groups were observed in patients with clinical data. The data were analyzed by SPSS23.0 measurement data input and statistics. In line with normal distribution and homogeneity of variance differences between groups were compared using two independent samples t test, with X + S. Non normal distribution, heterogeneity of variance and non parametric test for count data by chi square test or Fish Er exact test.P0.05 considered statistically significant. Results: 1. general conditions: To compare the observation group and the control group of patients in age, pregnant times, no significant previous cesarean and abortion times difference (P0.05) between the two groups: the observation group outcomes.2. average amount of bleeding (902.14 + 1060.3 ml), the average amount of red blood cell transfusion (3.89 + 3.28) U. control group, the average amount of bleeding (2546.7 + 1686.9) ml, the average volume of red blood cell transfusion (10.93 + 6.84) U. was statistically significant between the two groups in bleeding and transfusion of red blood cells. The difference of KCL before induction of fetal reduction than directly caesarean section, the amount of bleeding and blood transfusion were significantly reduced. The hospitalization expenses between the two groups showed no significant difference (P0.05). There was statistical significance difference (P0.05), hospitalization days before KCL treatment of fetal reduction hospitalization longer than direct cesarean group. Uterus resection: 0 cases in the observation group, the control group 2 渚，

本文編號：1370509