凶险性前置胎盘多学科协作诊疗模式临床研究

Clinical study of multidisciplinary collaborative diagnosis and treatment mode of pernicious placenta previa

目的探讨凶险性前置胎盘(pernicious placenta previa,PPP)多学科协作诊疗模式的临床特点。方法以2012年5月至2016年10月成都市第五人民医院收治的PPP患者86例为研究对象,根据随机数字表法分为对照组与观察组各43例。对照组予以专科诊疗模式,观察组采用多学科协作诊疗模式,比较两组妊娠期间并发症、手术结果,并记录两组母婴结局、比较产妇术后并发症发生情况。结果妊娠期间,对照组并发妊娠期糖尿病、子痫、贫血、体质量指数超标等并发症总发生率72.1%,显著高于观察组16.3%(P <0.05);两组均无死亡病例,但对照组术中出血量、输血量、子宫切除率均明显高于观察组(P <0.05);术后对照组累计大出血发生率明显高于观察组,终止妊娠孕周明显低于观察组(P <0.05);两组均无新生儿死亡,但对照组呼吸窘迫、低体重等发生率明显高于观察组,Apgar评分明显低于观察组(P <0.05);术后对照组并发症总发生率25.6%,明显高于观察组9.3%(P <0.05)。结论 PPP临床治疗中采用多学科协作诊疗模式优势明显,可显著降低妊娠期并发症风险,有效减少患者术中术后出血量,降低新生儿不良事件发生率,有助于患者术后恢复。

Objective To explore the clinical characteristics of multidisciplinary collaborative diagnosis and treatment mode of pernicious placenta previa(PPP).Methods 86 cases of patients with PPP in Chengdu Fifth People’s Hospital were selected for the study and divided into the control group and the observation group according to the random number table method,with 43 cases in each group.The control group was given the diagnosis and treatment mode of specialist treatment and the observation group was given multidisciplinary collaborative diagnosis and treatment mode.The postoperative complications and surgical results in the pregnancy duration were observed between the two groups,and the maternal and neonatal outcomes of the two groups were recorded and the postoperative complications were compared between the two groups.Results The overall incidence rate of combined diabetes mellitus,eclampsia,anemia,BMI and termination of pregnancy was 72.1 % in the control group,which was significantly higher than that in the observation group with 16.3 %(P<0.05).And there was no death case in the two groups,but the intraoperative blood loss amount,blood transfusion volume,hysterectomy rates were significantly higher in the control group than those in the observation group(P<0.05).The incidence rates of accumulative massive hemorrhage and interventional pulmonary embolism were significantly higher in the control group than those in the observation group,and the gestational age of termination of pregnancy was lower than that of the observation group(P<0.05).There was no death case in the neonate,and the incidence rate of respiratory distress,low body weight and pneumonia in the control group was significantly higher while the Apgar score was significantly lower than that in the observation group(P<0.05).The total incidence rate postoperative of complication was 25.6 % in the control group,which was significantly higher than that in the observation group with 9.3 %(P<0.05).Conclusion The multidisciplinary collaborative diagnosis and treatment mode has significant advantages in the treatment of PPP,can significantly reduce the risk of gestational complications and the postoperative blood loss amount and the incidence rate of neonatal adverse events,which can be helpful for the postoperative recovery.