腹主动脉球囊置入在凶险性前置胎盘剖宫产术中的临床应用

Clinical application of abdominal aortic balloon placement in cesarean section of pernicious placenta previa

目的:分析腹主动脉球囊置入在凶险性前置胎盘剖宫产术中的临床应用效果。方法:选取2015年6月至2018年6月于我院行剖宫产术的凶险性前置胎盘患者50例,根据手术方法分为常规组(n=30)和球囊组(n=20),所有患者均行常规剖宫产术,球囊组患者在剖宫产术之前先行腹主动脉球囊阻断术,比较两组患者术中、术后一般情况,分娩后胎儿的一般情况,患者住院期间及术后不良反应的发生情况。结果:球囊组患者的手术时间[(96.49±6.94)min vs.(101.49±10.09)min]、术中出血量[(932.93±81.97)ml vs.(2 010.49±288.39)ml]、术中输血量[(652.47±88.94)ml vs.(1 546.39±237.18)ml]及子宫切除率(5%vs. 30%)均显著低于常规组,差异有统计学意义(t=3.055、27.633、26.985,χ~2=4.678,P<0.05);两组患者的术中膀胱损伤率差异无统计学意义(0%vs. 3.33%,χ~2=0.680,P>0.05)。球囊组总住院时间[(4.69±0.34)d vs.(5.27±1.06)d]、弥散性血管内凝血发生率(0%vs. 20%)、失血性休克发生率(0%vs.23.3%)及肾功能异常率(5%vs. 33.3%)均显著低于常规组(t=2.064,χ~2=5.613、4.454、5.425,P<0.05);两组患者术后感染率(10%vs. 20%)差异无统计学意义(χ~2=0.399,P>0.05);两组患者分娩后胎儿体质量[(2.65±0.62)kg vs.(2.57±0.37)kg]、1 min Apgar评分[(8.49±1.65)分vs.(8.86±2.07)分]及5 min Apgar评分[(9.53±0.97)分vs.(9.72±1.06)分]比较差异无统计学意义(t=0.517、-0.701、-0.653,P>0.05);两组患者的术后不良反应发生率(3.3%vs. 15%)差异无统计学意义(χ~2=0.779,P>0.05)。结论:凶险性前置胎盘患者在行剖宫产前先行腹主动脉球囊阻断术,能改善患者术中及术后情况,同时降低其胎盘切除的可能性,且安全性相对较好。

Objective:To analyze the clinical application effect of abdominal aortic balloon placement in cesarean section of sinister placenta previa.Methods:A retrospective analysis was performed on the medical records of 50 patients with sinister placenta previa who underwent cesarean section in our hospital from June 2015 to June 2018.The patients were divided into routine group(n=30)and balloon group(n=20)according to the surgical method.Then,the intraoperative and postoperative conditions,general condition of the fetus after delivery,patients'hospitalization period and occurrence of postoperative adverse reactions of the two groups were compared.Results:The operation time of patients in the balloon group[(96.49±6.94)min vs(101.49±10.09)min],intraoperative blood loss[(932.93±81.97)ml vs.(2 010.49±288.39)ml],intraoperative blood transfusion[(652.47±88.94)ml vs.(1 546.39±237.18)ml]and hysterectomy rate(5%vs.30%)were significantly lower than the conventional group,and the difference was statistically significant(t=3.055,27.633,26.985,χ^2=4.678,P<0.05).There was no significant difference in the rate of intraoperative bladder injury between the two groups(0%vs.3.33%,χ^2=0.680,P >0.05).Total hospital stay in the balloon group[(4.69±0.34)d vs.(5.27±1.06)d],DIC incidence(0%vs.20%),incidence of hemorrhagic shock(0%vs.23.3%)and renal dysfunction rate(5%vs.33.3%)were significantly lower than those of the conventional group(t=2.064;χ^2=5.613,4.454,5.425;P<0.05).There was no significant difference in postoperative infection rate(10%vs.20%)between the two groups(χ^2=0.399,P >0.05).The fetal weight of the two groups after delivery[(2.65±0.62)kg vs.(2.57±0.37)kg]and 1 min Apgar score[(8.49±1.65)points vs.(8.86±2.07)points],5 min Apgar score[(9.53±0.97)points vs.(9.72±1.06)points]had no significant difference between the two time points(t=0.517,-0.701,-0.653;P >0.05);There was no significant difference in the incidence of postoperative adverse reactions(3.3%vs.15%)between the two groups(χ^2=0.779,P >0.05).Conclusions:Abdominal aortic balloon occlusion before cesarean section in sinister placenta previa can improve the intraoperative and postoperative conditions,and reduce the possibility of placental resection,and the safety is relatively good.