多学科系统化管理在凶险性前置胎盘中的应用研究

A system of multidisciplinary management in cases of pernicious placenta previa

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.