凶险型前置胎盘伴胎盘植入剖宫产术中止血方式分析

Analysis on hemostatic methods during cesarean section in patients with pernicious placenta previa complicated with placental implantation

目的探索凶险型前置胎盘伴胎盘植入剖宫产术中理想止血方式。方法选取2013年1月-2016年6月该院收治的凶险型前置胎盘伴胎盘植入患者70例,均采用剖宫产术结束妊娠,根据剖宫产术中采取的止血方式分为观察组(37例)与对照组(33例)。观察组止血方式为子宫外压迫止血法,对照组止血方式为子宫内压迫止血法,对比分析两组患者的手术时间、术中出血量、子宫切除率及产后出血率。结果观察组手术时间为(108±17)min,显著低于对照组(156±26)min;观察组术中出血量为(925±218)min,显著低于对照组(1 837±382)min;观察组术后住院时间为(7.25±1.92)d,显著低于对照组(9.11±2.07)d,两组比较差异均有统计学意义(t=9.236 0,P=0.000 0;t=12.434 6,P=0.000 0;t=3.899 7,P=0.000 2)。观察组子宫切除率(5.41%)、产后出血率(10.81%)、弥散性血管内凝血(DIC)发生率(21.62%)、重症监护室(ICU)转入率(40.54%)显著低于对照组(39.39%、48.48%、45.45%及81.82%),两组比较差异均有统计学意义(χ~2=11.968 1,P=0.000 0;χ~2=12.131 0,P=0.000 0;χ~2=4.491 0,P=0.036 2;χ~2=12.383 3,P=0.000 0);两组患者产褥感染率分别为2.70%和6.06%,差异无统计学意义(χ~2=0.010 3,P=0.924 3)。结论凶险型前置胎盘伴胎盘植入剖宫产术中应用子宫外压迫止血法疗效确切,具有手术时间及术后住院时间短,术中出血量少,子宫切除率、产后出血率、DIC发生率、ICU转入率低等优点。

Objective To explore the ideal hemostatic methods during cesarean section in patients with pernicious placenta previa complicated with placental implantation. Methods Seventy patients with pernicious placenta previa complicated with placental implantation treated in the hospital from January 2013 to June 2016 were selected,pregnancy was terminated by cesarean section,all the patients were divided into observation group（ 37 cases） and control group（ 33 cases） according to the hemostatic methods during cesarean section. The patients in observation group adopted hemostasis by extrauterine compression,and the patients in control group adopted hemostasis by intrauterine compression. The operation time,the amounts of intraoperative hemorrhage,uterine resection rates,and incidence rates of postpartum hemorrhage in the two groups were compared. Results The operation time in observation group was（ 108 ±17） minutes,which was statistically significantly shorter than that in control group [（ 156±26） minutes]（ t = 9. 236 0,P = 0. 000 0）; the amount of intraoperative hemorrhage in observation group was（ 925±218） ml,which was statistically significantly lower than that in control group [（ 1 837±382） ml]（ t =12. 434 6,P = 0. 000 0）; the postoperative hospitalization time in observation group was（ 7. 25±1. 92） days,which was statistically significantly shorter than that in control group [（ 9. 11±2. 07） days]（ t = 3. 899 7,P = 0. 000 2）; uterine resection rate,incidence rates of postpartum hemorrhage and disseminated intravascular coagulation（ DIC）,admission rate of ICU in observation group were 5. 41%,10. 81%,21. 62%,and 40. 54%,respectively,which were statistically significantly lower than those in control group（ 39. 39%,48. 48%,45. 45%,and 81. 82%,respectively）（ χ^2= 11. 968 1,P = 0. 000 0; χ^2= 12. 131 0,P = 0. 000 0; χ^2= 4. 491 0,P = 0. 036 2; χ^2= 12. 383 3,P =0. 000 0）. The incidence rates of puerperal infection in the two groups were 2. 70% and 6. 06%,respectively,there was no statistically significant difference between the two groups（ χ^2= 0. 010 3,P = 0. 924 3）. Conclusion The curative effect of hemostasis by extrauterine compression during cesarean section in patients with pernicious placenta previa complicated with placental implantation is good,and the method has the advantages of short operation time and postoperative hospitalization time,less bleeding,low hysterectomy rate,low incidence rates of postpartum hemorrhage and DIC,and low admission rate of ICU.