凶险型前置胎盘患者术前介入置管对改善母婴结局的探讨

Exploration of preoperative interventional therapy on improving maternal-infant outcomes in patients with sinister placenta previa

目的探讨凶险型前置胎盘患者术前介入治疗对围手术期指标、子宫切除率及母婴结局的影响。方法收集2015年2月至2019年2月于山东省淄博市第一医院分娩的凶险型前置胎盘患者64例,根据治疗方法分为观察组(介入组,30例)和对照组(非介入组,34例)。比较两组患者围手术期指标(术中出血量、手术时间、术后24 h出血量、住院时间)、术后并发症[子宫切除、产褥感染、弥漫性血管内凝血(DIC)、产后出血>2000 ml]发生率以及母婴结局(早产、新生儿窒息、新生儿死亡、1 min后Apgar评分)差异性。结果观察组患者术中出血量、术后24 h出血量均较对照组少,手术时间、住院时间均较对照组短(P<0.05),子宫切除、产褥感染、DIC、产后出血>2000 ml、早产发生率均较对照组低(P<0.05);两组新生儿窒息、新生儿死亡发生率和1 min后Apgar评分指标比较,差异均无统计学意义(P>0.05)。结论凶险型前置胎盘患者剖宫产术前行介入治疗可有效缩短手术时间、减少术中术后出血,并降低子宫切除、产褥感染等并发症发生率,有利于改善妊娠结局。

Objective To explore the effects of preoperative interventional therapy on perioperative indexes,hysterectomy rate and maternal-infant outcomes in patients with sinister placenta previa.Methods 64 patients with sinister placenta previa who delivered in our hospital from February 2015 to February 2019 were collected and divided into observation group(intervention group,30 cases)and control group(non-intervention group,34 cases)according to treatment methods.Perioperative indexes(intraoperative blood loss,operative time,24h postoperative blood loss,hospital stay),incidence rates of postoperative complications[hysterectomy,puerperal infection,disseminated intravascular coagulation(DIC),postpartum hemorrhage>2000 ml]and maternal-infant outcomes(premature birth,neonatal asphyxia,neonatal death,Apgar score after 1 min)were compared between the two groups.Results The intraoperative blood loss and 24h postoperative blood loss in observation group were less than those in control group,and the operative time and hospital stay were shorter than those in control group(P<0.05),and the incidence rates of hysterectomy,puerperal infection,DIC,postpartum hemorrhage>2000 ml and premature birth were lower than those in control group(P<0.05).There were no significant differences in the incidence rates of neonatal asphyxia and neonatal death and Apgar score after 1 min between the two groups(P>0.05).Conclusion Interventional therapy before cesarean section in patients with sinister placenta previa can effectively shorten the operative time,reduce intraoperative and postoperative blood loss,and reduce the incidence rates of complications such as hysterectomy and puerperal infection.and it is beneficial to improve pregnancy outcomes.