摘要
目的:探讨多学科系统化管理凶险性前置胎盘(PPP)对母儿妊娠结局的影响。方法:2013年1月至2015年2月在南京大学医学院附属鼓楼医院住院分娩的 PPP孕妇41例,其中经包括自体血贮备、术前核查、髂总动脉球囊预置等内容在内的多学科系统化管理者为系统管理组20例,未接受妊娠期管理者为对照组21例。分析这些病例的母儿妊娠结局。结果:2013年、2014年和2015年1--2月,凶险性前置胎盘分别占同期分娩总数的0.5‰(2/4402)、4.3‰(25/5762)和15.5‰(14/905),发生率大幅迅速增加,差异显著(P〈0.001)。系统管理组和对照组的产后出血量分别为710ml(230~6000ml)和1500ml(310~4515ml)ml,出血率分别为30.0%和61.9% 。系统管理组的产后出血量和出血率均低于对照组(P =0.06,P =0.07);产前自体血贮备量显著增高(P≤0.05),异体浓缩红细胞(RBC)输注量达到或超过4U 以上大量输血孕妇明显减少,早期发病率为15.0%,显著低于对照组的52.4%(P≤0.05)。结论:多学科系统化管理流程能减少 PPP围术期的严重并发症。
Objective:To investigate the impact of multidisciplinary care on the preg-nancy outcomes of pernicious placenta previa. Methods: From Jan. 2013 to Feb. 2015, 41 women of pernicious placenta previa were gave birth in Nanjing Drum Tower Hospital. Those who were managed by a multidisciplinary care team involving preoperative autologous blood do-nation,preoperation checklist,temporary balloon occlusion of the internal iliac arteries were in-cluded in the systematic care group,while those not under prenatal management were included in the control group. The pregnancy outcomes of the two groups were compared. Results:In 2013,2014,Jan. and Feb. in 2015,the incidence of pernicious placenta previa was 0. 5‰(2 /4402),4. 3‰(25 / 5762)and 15. 5‰(14 / 905)respectively,the occurrence rate increasing rap-idly with significant difference(P〈0. 001). Postpartum hemorrhage of the systematic care group was 710 ml(230 ~ 6000ml)with the rate of 30% ,lower than the 1500ml(310 ~ 4515ml)(P =0. 06)and the 61. 9% (P = 0. 07) of the control group. Preoperative autologous blood donation also increased with significance. The rate of allogeneic transfusion of RBC≥4U was decreased significently,with an early morbidity of 15. 0% ,which was much lower than the 52. 4% (P≤0. 05)of the control group. Conclusion:Multidisciplinary care decreases the severe morbidity of pernicious placenta previa.
出处
《现代妇产科进展》
CSCD
北大核心
2015年第8期561-564,共4页
Progress in Obstetrics and Gynecology
基金
国家临床重点专科建设项目(No:卫办医政函[2011]271号)
江苏省医学重点学科(No:XK201102)
关键词
凶险性前置胎盘
产后出血
多学科系统化管理
产前贮存式自体备血
妊娠结局
Pernicious placenta previa
Postpartum hemorrhage
A Multidisciplinary care team
Preoperative autologous blood donation
Pregnancy outcome