腹主动脉球囊阻断术对凶险性前置胎盘出血及感染风险的影响

The effect of abdominal aortic balloon occlusion on the risk of pernicious placenta previa bleeding and infection

目的探讨腹主动脉球囊阻断术对凶险性前置胎盘异常出血及感染风险的影响。方法回顾性分析2016年9月~2019年6月于淮安市妇幼保健院分娩且术前经超声及MRI检查提示为凶险性前置胎盘者100例。根据剖宫产术前是否行腹主动脉球囊阻断术将其分为球囊组(n=54)和传统组(n=46)。球囊组行低位腹主动脉球囊阻断术,传统组行传统剖宫产手术。比较两组术中出血量、输血量、术后抗生素应用时间、手术时间、产后住院时间,并分析产后出血、子宫切除、产后感染、失血性休克、转入ICU发生率。利用阿氏评分(Apgar评分)分析新生儿出生后1 min及5 min的窒息情况。术后电话随访6个月,分析两组月经复潮时间、恶露持续时间、不良事件发生情况。结果球囊组术中出血量、输血量均低于传统组,手术时间较传统组显著缩短(P<0.05)。球囊组产后出血率为12.96%,较传统组的30.43%显著降低(P<0.05)。两组新生儿1 min、5 min Apgar评分比较无显著差异(P>0.05)。球囊组术后有4例产妇出现动脉穿刺部位疼痛,但均为轻微疼痛,无需用药,症状于3~5 d内完全缓解,有1例下肢出现轻度血栓,经保守干预后,症状彻底缓解。球囊组恶露持续时间较传统组显著缩短(P<0.05),两组月经复潮时间比较无差异(P>0.05),且月经量、经期较孕前均无明显改变。结论与单纯剖宫产手术相比,低位腹主动脉球囊阻断术除能有效控制产后出血率外,还可缩短恶露持续时间,产后6个月内未见患者出现严重不良事件,安全性高。

Objective To explore the effect of abdominal aortic balloon occlusion on the risk of pernicious placenta previa bleeding and infection.Methods A retrospective analysis of 100 cases of placenta previa in Huai’an Maternal and Child Health Hospital from September 2016 to June 2019 was made.According to whether abdominal aortic balloon occlusion was performed before cesarean section,the patients were divided into balloon group(n=54)and traditional group(n=46).In the balloon group,abdominal aortic balloon occlusion was performed,while in the traditional group,traditional cesarean section was performed.The bleeding volume,blood transfusion volume,postoperative antibiotic application time,operation time and postpartum hospitalization time were compared between the two groups,and the incidence of postpartum hemorrhage,hysterectomy,postpartum infection,hemorrhagic shock and transfer to ICU were analyzed.Asphyxia was analyzed by Apgar score at 1 and 5 minutes after birth.The patients in the two groups were followed up for 6 months by telephone.The time of menorrhea,duration of lochia and adverse events were analyzed.Results The amount of bleeding and blood transfusion in the balloon group were lower than those in the traditional group,and the operation time was significantly shorter than that in the traditional group(P<0.05).The postpartum hemorrhage rate of the balloon group was 12.96%,which was significantly lower than that of the traditional group(30.43%)(P<0.05).There was no significant difference in Apgar scores between the two groups(P>0.05).In the balloon group,there were 4 cases of pain in the puncture site of the artery,but all of them were slight pain,without medication,the symptoms were completely relieved within 3~5 days,and there was 1 case of mild thrombus in the lower extremity.After conservative intervention,the symptoms were completely relieved.The duration of lochia in the balloon group was significantly shorter than that in the traditional group(P<0.05).There was no difference between the two groups in the time of menstruation(P>0.05),and there was no significant change in the amount and period of menstruation.Conclusion Compared with simple cesarean section,low abdominal aortic balloon occlusion can not only effectively control the rate of postpartum hemorrhage,but also shorten the duration of lochia.No serious adverse events occurred within 6 months postpartum,so it is safe.