彩色多普勒超声预测瘢痕妊娠患者术中大出血风险的价值分析

Value of color Doppler ultrasound in predicting risk of intraoperative massive hemorrhage inpatients undergoing cesarean scar pregnancy

目的探讨彩色多普勒超声预测瘢痕妊娠(CSP)患者术中大出血风险的价值。方法选取2017年3月—2019年3月本院收治的82例CSP患者作为研究对象,依据手术出血量分为A组(出血量≥400 ml,33例)和B组(出血量<400 ml,49例)两组。比较两组病灶长径及宽径,子宫残余肌层厚度、RI水平、HCG水平、病灶分型及血流分级,采用Logistic回归分析大出血患者相关危险因素。结果A组的病灶长径及宽径明显较B组更大,子宫残余肌层厚度明显薄于B组(P<0.05);两组RI水平及HCG水平比较,差异无统计学意义(P>0.05);A组的内生型、外生型占比显著高于B组(P<0.05);A组的Ⅰ、Ⅱ级血流分级占比显著低于B组,Ⅲ级占比显著高于B组(P<0.05);Logistic回归分析显示病灶长径及宽径、分型、血流分级、残余肌层厚度、血流分级均为CSP患者术中大出血的相关危险因素。结论彩色多普勒超声能够于术前准确预测CSP患者术中大出血风险,为临床治疗提供预警参考价值。

Objective To investigate the value of color Doppler ultrasound in predicting risk of intraoperative massive hemorrhage in patients undergoing cesarean scar pregnancy(CSP).Methods 82 patients undergoing CSP who were admitted to the hospital from March 2017 to March 2019 were enrolled.They were divided into group A(bleeding loss equal to or over 400 ml,n=33)and group B(bleeding loss less than 400 ml,n=49)according to surgical bleeding loss.The long diameter and wide diameter of lesions,thickness of residual myometrium,RI level,HCG level,lesion classification and blood flow grading were compared between the two groups.Logistic regression analysis was performed to analyze related risk factors of massive hemorrhage for CSP patients.Results The long diameter and wide diameter of lesions in group A were significantly larger than those in group B,while thickness of residual myometrium was significantly thinner than that in group B(P<0.05).There was no significant difference in RI level or HCG level between the two groups(P>0.05).The proportion of endogenous and exogenous types in group A was significantly higher than that in group B(P<0.05),while proportion of blood flow grading at grade Ⅰ and Ⅱ was significantly lower than that in group B,and proportion of grade Ⅲ was significantly higher than that in group B(P<0.05).Logistic regression analysis showed that long diameter and wide diameter of lesions,classification,blood flow grading,and thickness of residual myometrium were related risk factors for intraoperative massive hemorrhage in patients undergoing CSP.Conclusions Color Doppler ultrasound could accurately predict risk of intraoperative massive hemorrhage in patients undergoing CSP before surgery,and provide early warning reference value for clinical treatment.