本文選題：兇險(xiǎn)性前置胎盤 + 胎盤植入�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過分析兇險(xiǎn)性前置胎盤患者的臨床資料,探討兇險(xiǎn)性前置胎盤對妊娠結(jié)局的影響及兇險(xiǎn)性前置胎盤的管理對改善母兒預(yù)后重要性。方法:本文以2012年1月至2016年12月大連醫(yī)科大學(xué)附屬大連市婦幼保健院住院剖宮產(chǎn)分娩的68兇險(xiǎn)性前置胎盤患者為研究對象。根據(jù)兇險(xiǎn)性前置胎盤是否伴有胎盤植入,分為兇險(xiǎn)性前置胎盤伴胎盤植入組(A組,n=33),兇險(xiǎn)性前置胎盤無胎盤植入組(B組,n=35);根據(jù)手術(shù)時機(jī)分為擇期手術(shù)組(C組,n=56),急診手術(shù)組(D組,n=12)。結(jié)果:1.近5年大連市婦幼保健院瘢痕子宮再分娩人數(shù)比例逐年上升,由4.53%增長至9.14%。兇險(xiǎn)性前置胎盤的發(fā)病率由2012年的0.02%逐年上升至2016年的0.16%,5年間PPP發(fā)病率升高8倍。2.兇險(xiǎn)性前置胎盤患者中年齡35歲多于年齡≥35歲(60.29%/39.71%),有流產(chǎn)史的患者多于無流產(chǎn)史患者(79.45%/20.59%)。剖宮產(chǎn)間隔5-10年的患者多于時間間隔不足5年及大于10年的患者(50.00%/23.53%/26.47%)。3.A組患者術(shù)中失血量及血液制品使用率高于B組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。D組患者術(shù)中失血量及血液制品使用率與C組比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4.A組患者產(chǎn)后出血、失血性休克、DIC、子宮切除及產(chǎn)褥期感染等發(fā)生率均明顯高于B組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。A組產(chǎn)后出血的發(fā)生率隨著分娩孕周的延長而升高,兩者之間存在顯著相關(guān)性(R=0.926,P=0.00)。D組患者產(chǎn)后出血、DIC、膀胱損傷、子宮切除及產(chǎn)褥期感染等發(fā)生率與C組比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。D組失血性休克發(fā)生率高于C組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5.A組早產(chǎn)、轉(zhuǎn)入NICU的發(fā)生率、新生兒并發(fā)癥及新生兒體重與B組比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。D組早產(chǎn)、轉(zhuǎn)入NICU的發(fā)生率及新生兒并發(fā)癥與C組比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.兇險(xiǎn)性前置胎盤發(fā)病率逐年升高。2.兇險(xiǎn)性前置胎盤發(fā)生胎盤植入的風(fēng)險(xiǎn)大,當(dāng)伴有胎盤植入時術(shù)中更易發(fā)生難控性大出血,致失血性休克、DIC、子宮切除及產(chǎn)褥期感染等發(fā)生率升高。3.兇險(xiǎn)性前置胎盤應(yīng)盡量擇期手術(shù)。PPP伴有胎盤植入時,可考慮將分娩孕周提前至36周前,如繼續(xù)延長孕周,發(fā)生產(chǎn)后出血的風(fēng)險(xiǎn)明顯增加。
[Abstract]:Objective: to investigate the influence of dangerous placenta previa on pregnancy outcome and the importance of management of dangerous placenta previa to improve the prognosis of mother and infant by analyzing the clinical data of patients with dangerous placenta previa. Methods: from January 2012 to December 2016, 68 patients with perilous placenta previa in Dalian Maternal and Child Health Hospital, Dalian Medical University, were studied. According to the risk of placenta previa associated with placenta accreta, it was divided into two groups: group A with severe placenta previa with placenta accreta, group A with severe placenta previa without placenta accreta, group B with placenta accreta without placenta previa group B, group B with placenta accreta group B, group B with no placenta accreta, group C with group C and group D with emergency operation group n125A according to the timing of operation. The result is 1: 1. In the past 5 years, the proportion of scar uterus redelivery in Dalian Maternal and Child Health Hospital increased year by year, from 4.53% to 9.14%. The incidence of menacing placenta previa has risen from 0. 02% in 2012 to 0. 16% in 2016. The incidence of PPP has risen eightfold in five years. In the patients with dangerous placenta previa, 35 years old and more than 35 years old, 60.29 / 39.71% and 79.45% / 20.59% had a history of abortion more than those without a history of abortion. The number of patients with cesarean section between 5 and 10 years was more than those with less than 5 years and more than 10 years. The blood loss and utilization rate of blood products in group A were higher than those in group B. There was no significant difference in blood loss and utilization rate of blood products between group D and group C. The incidence of postpartum hemorrhage, hemorrhagic shock and DICs, hysterectomy and puerperal infection in group A were significantly higher than those in group B. There was significant difference between the two groups in the incidence of postpartum hemorrhage with the prolongation of gestational weeks, and there was a significant correlation between the two groups. There was a significant correlation between the two groups in postpartum hemorrhage and bladder injury. The incidences of hysterectomy and puerperal infection in group C were not significantly higher than those in group C (P 0.05). The incidence of hemorrhagic shock in group D was higher than that in group C. There was a significant difference between the two groups in the incidence of premature delivery and transfer to NICU in group P0.05. 5. There was no significant difference in neonatal complications and neonatal body weight between group B and group B (P 0.05). There was no significant difference in the incidence of neonatal complications and neonatal complications compared with group C (P 0.05). Conclusion 1. The incidence of dangerous placenta previa increased year by year. The risk of placenta accreta is high in dangerous placenta previa. It is more likely to occur intractable hemorrhage during the operation when placenta accreta is accompanied by placenta placenta. The incidence of hemorrhagic shock and DICs, hysterectomy and puerperal infection are increased by 0.3%. When severe placenta previa should be operated on for as long as possible. PPP with placenta accreta may consider advancing the gestational week of delivery to 36 weeks. If the gestational weeks are prolonged, the risk of postpartum hemorrhage will increase significantly.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.2

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