凶险性前置胎盘产妇发生弥散性血管内凝血和失血性休克及子宫切除的相关因素分析

Analysis of Related Factors of Disseminated Intravascular Coagulation,Hemorrhagic Shock and Hysterectomy in Patient with Pernicious Placenta

目的:探讨凶险性前置胎盘产妇发生弥散性血管内凝血(DIC)、失血性休克、子宫切除不良妊娠结局的相关因素。方法:回顾性分析2012年1月1日至2016年12月31日于中国医科大学附属盛京医院行剖宫产终止妊娠的96例凶险性前置胎盘产妇的临床资料,对其发生DIC、失血性休克及子宫切除不良妊娠结局的有关因素行单因素和二项分类Logistic回归模型分析。结果:Logistic回归模型分析示:术中宫腔填塞纱布或球囊、行腹主动脉球囊阻滞是产妇发生DIC的保护性因素(OR<1,P<0.05);而伴有胎盘植入、人工流产次数多是发生DIC的独立危险因素(OR>1,P<0.05)。术中宫腔填塞纱布或球囊是产妇发生失血性休克的保护性因素(OR<1,P<0.05);而伴有胎盘植入、人工流产次数多是发生失血性休克的独立危险因素(OR>1,P<0.05)。术中行腹主动脉球囊阻断是切除子宫的保护性因素(OR<1,P<0.05);而伴有胎盘植入、孕次数越多是发生子宫切除的独立危险因素(OR>1,P<0.05)。结论:凶险性前置胎盘产妇孕次越多、人工流产次数越多、合并胎盘植入时,发生不良妊娠结局的风险越高。术中行宫腔填塞纱布或球囊压迫止血和行腹主动脉球囊阻断能降低不良妊娠结局的风险。

Objective:To investigate the factors related with disseminated intravascular coagulation(DIC),hemorrhagic shock and hysterectomy in pernicious placenta previa.Methods:Retrospectively analyzed 96 cases between January 2012 and December 2016 in Shengjing Hospital Affiliated to China Medical University by binary Logistic regression model.Results:Intraoperative uterine cavity filling with gauze or balloon and abdominal aortic balloon block were protective factors for the occurrence of DIC(OR<1,P<0.05),hemorrhagic shock(OR<1,P<0.05)and hysterectomy(OR<1,P<0.05).Placental implantation and more induced abortion were independent risk factors for DIC(OR>1,P<0.05),hemorrhagic shock(OR>1,P<0.05).Placental implantation and more pregnancies were independent risk factors for hysterectomy(OR>1,P<0.05).Conclusions:The risk of adverse pregnancy outcome is higher in the pernicious placenta previa withmore pregnancies,repeatedly induced abortions and placenta implantation.Intrauterine gauze or balloon filling during operation and infrarenal abdominal aorta balloon catheter can reduce the risk of adverse pregnancy outcomes.