生物蛋白胶封堵在胎膜早破治疗中的临床应用

Effect of Fibrin Glue Combined with Cervical Cerclage on Premature Rupture of Membranes

目的:将使用生物蛋白胶封堵的胎膜早破患者及不使用生物蛋白胶封堵的胎膜早破患者从孕妇、胎儿、新生儿的影响等多个方面进行比较,观察生物蛋白胶封堵技术治疗胎膜早破的疗效。方法:将2011年我院产科共收治妊娠<32周胎膜早破患者48例与2010年收治的妊娠<32周胎膜早破患者32例进行比较。2011年收治的所有患者除了采取绝对卧床、抬高臀部、定期B超检查、监测孕妇及胎儿情况、使用抗生素预防感染、保胎等传统治疗外,还在确诊后行生物蛋白胶封堵。2010年的患者仅采用绝对卧床、抬高臀部、定期B超检查、监测孕妇及胎儿情况、使用抗生素预防感染、保胎等传统治疗观察治疗后孕妇羊水指数,胎儿双顶径,新生儿出生时体重及孕妇的不良反应,比较两种治疗的差异。结果:研究组在封堵治疗过程中均一次封堵成功,没有不良反应发生,其中有2例孕妇术后1周阴道流水停止。B超检查显示羊水指数均在(6±2)cm,胎儿每周双顶径增长均达到(0.15±0.02)cm,延长孕周最短(5±2)周,10例早产,38例继续妊娠至37周。新生儿出生时体重为(2 000±260)g,无1例发生NRDS。对照组中胎龄延长最长达到10 d,最短者24 h内出现早产分娩,早产儿平均体重1 400 g,均发生NRDS,有2例放弃治疗,4例在NICU行治疗,最终因各种并发症死亡。48例行封堵治疗孕妇未发生过敏反应,无阴道出血及产后出血和感染等。结论:应用生物蛋白胶结合宫颈环扎术治疗胎膜早破,手术操作简单,可延长了孕周,提高了新生儿成活率,无不良反应,具有广泛的应用前景。

Objective To observe the effect of fibrin glue combined with cervical cerclage on premature rupture of membranes.Method 48 pregnancy patients （pregnancy 〈32 weeks） were treated in hospital.The method of fibrin glue sealing was applied to treat the premature rupture of membranes.Amniotic fluid index,fetal biparietal diameter,body weight of birth,and maternal side effects was observed after treatment of pregnant women.Results All patients underwent just one closure.There was no case of adverse reactions,and the volume of postoperative vaginal water was significantly reduced.Two cases of vaginal flow stopped after one week.Leakage of amniotic fluid volume decreased obviously in all patients.B-ultrasound once a week showed the amniotic fluid index were 6±2 cm,and fetal biparietal diameter increased 0.15±0.02 cm per week,extending the shortest gestational age （5 ± 2） weeks.10 cases had premature delivery.38 cases continued pregnancy to 37 weeks.Neonatus had birth weight of 2000 ± 260 g,and did not occur NRDS.Over the same period 38 patients who did not block the cervix miscarriage but only for medical treatment,extended the gestational age up to 10 days,preterm birth within 24 hours for the shortest,and the average weight of 1400 g for premature children,and NRDS occurred.Two gave up treatment,and 4 patients live in NICU treatment,but finally failed due to various complications.48 cases of pregnant women all had no allergic reaction,no vaginal bleeding,no fever before and after the termination of pregnancy and no postpartum hemorrhage and infection.Conclusion The fibrin glue combined with cervical cerclage treatment on premature rupture of membranesn has a wide application prospect for its advantages like operating simply,extending the gestational age and improving neonatal survival rate,and without adverse reaction.