超声引导下髂总动脉阻断联合氨甲环酸预防前置胎盘产后出血

Combination of Common Iliacballoon Preset with Ultrasound Guiding and Tranexamic Acid in Prevention of Bleeding Caused by Placenta Previa

目的探讨B超引导下双侧髂总动脉球囊阻断术并联合术中泵注氨甲环酸对前置胎盘伴胎盘植入产妇剖宫产术出血量的影响。方法回顾性分析2014年4月至2018年5月在昆明医科大学第二附属医院行剖宫产的44例前置胎盘伴胎盘植入产妇的临床资料,其中常规行剖宫产术的22例产妇为对照组,另外在B超引导下行双侧髂总动脉球囊阻断术,术中泵注标准剂量剂量的氨甲环酸的产妇为实验组。对2组产妇的术中出血量、输血量、子宫切除率及术后住院时间等情况进行比较统计分析。结果实验组产妇的术中失血量、输红细胞的量分别为900 (600,3 125) mL、0 (0,750) mL,明显低于对照组的3 400 (1 500,5 000) mL、800 (600,2 000)mL,差异均有统计学意义(P<0.05);实验组中有2例产妇切除子宫,对照组有9例,差异有统计学意义(P<0.05);实验组产妇术后住院时间为(4.0±1.0) d,短于对照组的(8.3±1.6) d,差异有统计学意义(P<0.01)。结论超声引导下髂总动脉阻断联合术中应用氨甲环酸可以明显减少前置胎盘伴胎盘植入产妇剖宫产术中出血量、术中输血量以及术后住院天数,最大程度保留子宫,技术安全、可行,避免了母胎放射线的损害。

Objective To evaluate the clinical application value of combination of common iliac balloon preset with ultrasound guiding and injection of tranexamic acidtranexamic acid in prevention of bleeding caused by complete placenta previa with placenta accreta. Methods From April 2014 to May 2018, 22 cases of complete placenta previa with placenta accreta were treated with temporary balloon occlusion of the common iliac artery and intravenous injection of tranexamic acid (the study group)before cesarean, and 22 cases of complete placenta previa with placenta accreta did not receive balloon occlusion and intravenous injection of tranexamic acid(the control group). The intraoperative blood loss,intraoperative blood transfusion volume, urine volume, operation time,the rate of bladder injury and hysterectomy were recorded and compared. Also, the related complications were compared retrospectively. Results The blood loss and blood in the study group were 900(600,3125)mL and 0(0,750)mL, while 3400(1500,5000)mL and 800(600, 2000)mL in the control group,which showed statistic significance(P<0.05). Two cases in the study group had hysterectomy, which was lower than that in the control group(9 cases)(P<0.05). The hospitalization time after operation was (4.0±1.0)days in the study group, compared with(8.3±1.6)days in the control group, and the difference was statistically significant(P<0.01). Conclusion Combination of common iliac balloon preset with ultrasound guiding and intravenous injection of tranexamic acid is an effective and safe method to control intraoperative blood loss, blood transfusion, the hospitalization time after operation and can decrease the rate of hysterectomy in patients of placenta accreta. Therefore, the technique is safe, feasible and can protect the maternal and fetus from radiation.