發(fā)布時(shí)間：2018-12-14 10:42

【摘要】：目的：對(duì)兇險(xiǎn)型與非兇險(xiǎn)型前置胎盤孕婦基本情況進(jìn)行比較,明確兇險(xiǎn)型前置胎盤發(fā)病的危險(xiǎn)因素；分析湘雅醫(yī)院2011-2013年兇險(xiǎn)型及非兇險(xiǎn)型前置胎盤圍手術(shù)期處理上的變化,探討其與妊娠結(jié)局的關(guān)系。 方法：采用病例-對(duì)照(case-control study,CCT)研究,收集2011年1月-2013年12月在中南大學(xué)湘雅醫(yī)院產(chǎn)科病房住院并終止妊娠的前置胎盤單胎孕產(chǎn)婦345例的臨床資料并對(duì)其進(jìn)行回顧性分析,其中兇險(xiǎn)型100例,非兇險(xiǎn)型245例。收集的資料包括患者基本情況,臨床特點(diǎn),圍手術(shù)期處理及新生兒結(jié)局等。 結(jié)局：1.對(duì)兇險(xiǎn)型前置胎盤基本情況行單因素分析,其中7個(gè)因素有統(tǒng)計(jì)學(xué)意義,分別為文化程度、居住地、孕次、產(chǎn)次、剖宮產(chǎn)次、人流次數(shù)、是否行輔助生殖技術(shù)等。多因素分析中有3個(gè)因素進(jìn)入多因素回歸模型。分別是居住地、剖宮產(chǎn)次、是否行輔助生殖技術(shù)。其中剖宮產(chǎn)次是兇險(xiǎn)型前置胎盤的危險(xiǎn)因素,比值比(odds ratio,OR)為20.294。2.兇險(xiǎn)型前置胎盤胎盤植入的發(fā)生率明顯高于非兇險(xiǎn)型前置胎盤(P0.05),超聲是診斷胎盤植入的主要輔助工具。3.2011年-2013年我院收治的前置胎盤患者逐年增加,其中2013年較2011年兇險(xiǎn)型前置胎盤增加12倍,非兇險(xiǎn)型前置胎盤增加60%。4.2011-2013年前置胎盤患者術(shù)前及術(shù)后血紅蛋白、分娩孕周等方面比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5.2011-2013年前置胎盤子宮動(dòng)脈介入栓塞、宮腔填塞紗條等方面比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。其中三年兇險(xiǎn)型前置胎盤患者子宮切除發(fā)生率、出血量、輸血量比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。6.2011-2013年前置胎盤患者新生兒結(jié)局比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論： 1.兇險(xiǎn)型前置胎盤的發(fā)生與剖宮產(chǎn)次有關(guān)。 2.兇險(xiǎn)型前置胎盤具有較高的胎盤植入率；超聲是診斷胎盤植入的主要輔助工具。 3.2011-2013年前置胎盤發(fā)生率增加,其中兇險(xiǎn)型前置胎盤增加明顯。 4.圍手術(shù)期處理的進(jìn)步及子宮下段環(huán)形縫扎術(shù)的應(yīng)用,使得兇險(xiǎn)型前置胎盤孕婦子宮切除發(fā)生率、產(chǎn)后出血量、輸血量明顯降低。
[Abstract]:Objective: to compare the basic conditions of pregnant women with dangerous placenta previa and to identify the risk factors of placenta previa. The changes of perioperative management of placenta previa in Xiangya Hospital from 2011 to 2013 were analyzed and the relationship between them and pregnancy outcome was discussed. Methods: a case-control (case-control study,CCT) study was used. From January 2011 to December 2013, 345 pregnant women with single placenta previa who were hospitalized and terminated in the obstetrical ward of Xiangya Hospital of Central South University were collected and analyzed retrospectively, including 100 cases of dangerous type and 245 cases of non-dangerous type. The data collected include the patient's basic condition, clinical features, perioperative management and neonatal outcome. Outcome: 1. Univariate analysis was carried out on the basic condition of the dangerous placenta previa. Seven factors were statistically significant: education degree, place of residence, pregnancy, labor, cesarean section, number of abortion, assisted reproductive technique, etc. In multivariate analysis, three factors entered the multivariate regression model. Place of residence, cesarean section, whether to use assisted reproductive technology. Cesarean section was a dangerous risk factor for placenta previa, and the ratio (odds ratio,OR) was 20.294.2. The incidence of severe placenta previa was significantly higher than that of non-ferocious placenta previa (P0.05), and ultrasound was the main auxiliary tool for the diagnosis of placenta accreta. 3. The number of placenta previa patients admitted to our hospital from 2011 to 2013 increased year by year. In 2013, there was a 12-fold increase in the number of placenta previa and 60 times more hemoglobin in patients with placenta previa from 2011 to 2013. There was no significant difference in pregnancy weeks (P0.05). 5. There was significant difference in placenta previa uterine artery interventional embolization and uterine cavity packing gauze (P0.05) from 2011 to 2013. Among them, the incidence of hysterectomy, the amount of blood loss and the amount of blood transfusion were significantly different in three years of dangerous placenta previa (P0.05). 6. There was no significant difference in neonatal outcome of placenta previa in 2011-2013 (P0.05). Conclusion: 1. The occurrence of dangerous placenta previa is related to cesarean section. 2. Placenta previa has a high rate of placenta accreta and ultrasound is the main assistant tool for the diagnosis of placenta accreta. 3. The incidence of placenta previa increased significantly in 2011-2013, especially in dangerous placenta previa. 4. The progress of perioperative management and the application of circular suture in lower uterine segment resulted in a significant decrease in the rate of hysterectomy, postpartum hemorrhage and blood transfusion in the pregnant women with dangerous placenta previa.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 關(guān)佳;劉玉臣;劉穎嫵;尹紅月;;剖宮產(chǎn)后子宮切口妊娠至足月活胎1例[J];中國(guó)現(xiàn)代醫(yī)生;2008年13期

2 郝敏,王志蓮;髂內(nèi)動(dòng)脈結(jié)扎在晚期產(chǎn)后出血中的應(yīng)用價(jià)值[J];中國(guó)實(shí)用婦科與產(chǎn)科雜志;2001年02期

3 郭紅霞;王潔;;兇險(xiǎn)型前置胎盤的治療進(jìn)展[J];現(xiàn)代婦產(chǎn)科進(jìn)展;2013年01期

4 陶春梅;李映桃;程澄;黃蓓;鐘柳英;;前置胎盤伴胎盤植入行子宮切除27例臨床分析[J];中華婦幼臨床醫(yī)學(xué)雜志(電子版);2014年01期

，

本文編號(hào)：2378474