【摘要】：目的:評(píng)價(jià)動(dòng)脈序貫介入治療(髂內(nèi)動(dòng)脈置管+封堵/子宮動(dòng)脈或髂內(nèi)動(dòng)脈栓塞)對(duì)兇險(xiǎn)型前置胎盤(pán)(PPP)出血的治療效果。方法:選取在我院診治的有胎盤(pán)植入高危因素的69例PPP患者,其中29例給予傳統(tǒng)的治療方法(對(duì)照組),40例給予動(dòng)脈序貫介入治療(觀察組)。比較分析兩組患者的術(shù)中出血量、輸紅懸量、子宮切除率、剖宮產(chǎn)手術(shù)時(shí)間、剖宮產(chǎn)術(shù)后24h出血量、術(shù)后住院時(shí)間、術(shù)后抗生素使用時(shí)間及并發(fā)癥(疼痛、發(fā)熱、感染及其它并發(fā)癥)發(fā)生率。結(jié)果:觀察組與對(duì)照組的術(shù)中出血量[(868.5±549.77)ml vs(1506.90±1417.39)ml]、輸紅懸量[(1.50±1.40)U vs(2.72±2.00)U]、子宮切除率(2.50%vs 17.24%)、剖宮產(chǎn)手術(shù)時(shí)間[(58.86±20.33)min vs(70.83±29.26)min]、術(shù)后疼痛發(fā)生率(81.25%vs 48.28%)、其它并發(fā)癥發(fā)生率(0.00%vs 10.35%)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組的剖宮產(chǎn)術(shù)后24h出血量、術(shù)后住院時(shí)間、術(shù)后抗生素使用時(shí)間、疼痛VAS評(píng)分、術(shù)后發(fā)熱發(fā)生率、術(shù)后感染發(fā)生率比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組產(chǎn)婦(子宮切除者除外)均于停止哺乳后1~3月月經(jīng)恢復(fù)情況正常;42天常規(guī)新生兒體檢,血象、肝功能及神經(jīng)系統(tǒng)檢查無(wú)明顯異常、新生兒均無(wú)血液系統(tǒng)疾病。結(jié)論:動(dòng)脈序貫介入治療PPP有效、可行,且對(duì)母嬰安全。
[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 鹵549.77) ml vs (1506.90 鹵1417.39) ml], red suspension volume [(1.50 鹵1.40) U vs (2.72 鹵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 鹵20.33) min vs (70.83 鹵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.
【作者單位】： 成都市婦女兒童中心醫(yī)院產(chǎn)科;成都市婦女兒童中心醫(yī)院放射科;
【基金】：成都市衛(wèi)生局課題(No:2014061) 國(guó)家科技支撐計(jì)劃課題(No:2014BAI05B00) 妊娠合并危急重癥救治技術(shù)及防控模式研究(No:2014BAI05B05)
【分類號(hào)】：R714.5

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