凶险型前置胎盘并发胎盘穿透性植入患者剖宫产术中球囊阻断腹主动脉的应用评价

Application of temporary ballon occlusion of the abdominal aorta in patients with pernicious placenta previa and placenta accrete

目的探究凶险型前置胎盘并发胎盘穿透性植入患者剖宫产术中以球囊阻断腹主动脉对手术以及新生儿预后的意义。方法选择2011年1月至2016年1月本院收治的134例凶险型前置胎盘并发胎盘穿透性植入患者，其中69例剖宫产术中以腹主动脉球囊阻断腹主动脉血流（观察组），另65例剖宫产术前未预置腹主动脉球囊导管（对照组），对两组患者手术情况及新生儿预后情况进行统计比较。结果观察组的手术时间[（65．2±6．3）min vs（93．2±8．8）min]、出血量[（923．2±188．6）ml vs（2791．8±336．2）m1]、输血量[（423．7±59．3）ml vs（1581．6±68．3）m1]、凝血酶原时间[（9．3±1．1）s vs（12．4±1．5）s]、子宫切除率[0 vs 7．7％（5／65）]、住院时间[（5．2-4-0．9）d vs（6．8±1．1）d]以及转重症监护室率[1．4％（1／69）VS12．3％（8／65）]均显著低于对照组，差异均有统计学意义（P〈0．05）；两组新生儿1min、5min Apgar评分以及出生体重差异无统计学意义（P〉0．05）。结论凶险型前置胎盘并发胎盘穿透性植入剖宫产患者以球囊阻断腹主动脉，可使术中出血量有效减少并降低子宫切除风险。

Objective To explore the influence on intraoperative hemorrhage and relative compli- cations of temporary balloon occlusion of the abdominal aorta in cesarean section for the pernicious placenta previa and placenta aecreta. Methods One hundred and thirty-four cases of pernicious placenta previa and placenta acerete from January 2011 to January 2016 were analyzed retrospectively. Before the cesareans, temporary balloon occlusion in abdominal aorta was carried out in 69 patients （observation group）. The other 65 patients didnt get the balloon occlusion in abdominal aorta （control group）. The situation during and after the operation and relative complications were compared. Results The operation duration [ （65.2 ± 6. 3）min vs （93.2± 8.8）min] , postpartum hemorrhage [ （923.2 ± 188.6）ml vs （2 791.8 ±336. 2）roll, intraoperative blood transfusion [ （423.7 ± 59. 3 ）ml vs （1 581.6 ± 68.3）ml] , the prothrombin time during the operation [（ 9. 3 ± 1.1 ） s vs （ 12.4±1.5 ） s ], the hysterectomy rate [ 0 vs 7.7% （ 5/65 ）], hospitaliza- tion time [ （5.2 ± 0. 9）d vs （6. 8 ± 1.1 ）d], and the rate of transferring to intensive care unit [ 1.4% （ 1/ 69 ） vs 12. 3 % （8/65） ] in the observation group were lower than control group, with a statistical significant difference （ P 〈 0. 05 ）. There was no significant difference between two groups in Apgar score and birth weight of the neonate （ P 〉 0.05 ）. Conclusions Temporary balloon occlusion of the abdominal aorta in ce- sarean section is a safe and effective technique, which can reduce the relative complications, such as the volume of bleeding and the risk of hysterectomy.