剖宫产疤痕妊娠术中出血的影响因素分析

Analysis of risk factors of hemorrhage in cesarean scar pregnancy

目的探讨剖宫产疤痕妊娠(CSP)术中出血的影响因素。方法62例CSP患者,均行手术终止妊娠治疗,根据术中出血量不同分为少量术中出血组(术中出血量<100ml,48例)和大量术中出血组(术中出血量≥100ml,14例)。分析CSP患者术中出血的影响因素。结果单因素分析发现,年龄、宫腔镜手术史、胚芽心管搏动、手术时间与CSP患者术中出血有关(P<0.05)。停经时间、绒毛膜促性腺激素(HCG)值、孕囊大小、手术方式、并发症与CSP患者术中出血无关(P>0.05)。Logistic回归分析发现,有宫腔镜手术史是CSP患者术中出血的独立保护因素[OR=0.257,95%CI=(0.071,0.935),P=0.039<0.05];有胚芽心管搏动[OR=5.286,95%CI=(1.044,26.757),P=0.044<0.05]和手术时间>30 min[OR=1.072,95%CI=(1.019,1.127),P=0.007<0.05]是CSP患者术中出血的独立危险因素。结论有胚芽心管搏动及手术时间长是CSP患者术中出血量增多的独立危险因素,因此提倡CSP患者应早诊断早处理,并于手术治疗时选择对术式操作经验丰富熟练的术者,尽量缩短手术操作时长。

Objective To discuss the influencing factors of bleeding during cesarean scar pregnancy(CSP). Methods A total of 62 CSP patients all received surgical termination of pregnancy. According to the amount of intraoperative hemorrhage, they were divided into small amount of intraoperative hemorrhage(intraoperative hemorrhage <100 ml, 48 cases) and large amount of intraoperative hemorrhage group(intraoperative hemorrhage ≥100 ml, 14 cases). The influencing factors of intraoperative bleeding in CSP patients was analyzed. Results Univariate analysis found that age, history of hysteroscopic surgery, embryonic heart beat, and operation time were correlated to intraoperative bleeding in CSP patients(P<0.05);the time of menopause, human chorionic gonadotropin(HCG) value, gestational sac size, operation method, and complications were not related to intraoperative bleeding in CSP patients(P>0.05). Logistic regression analysis showed that the history of hysteroscopic surgery was an independent protective factor for intraoperative bleeding in CSP patients [OR=0.257, 95% CI=(0.071, 0.935), P=0.039<0.05];embryonic cardiac beating [OR=5.286, 95% CI=(1.044, 26.757), P=0.044<0.05] and operation time>30 min [OR=1.072, 95% CI=(1.019, 1.127), P=0.007<0.05] were independent risk factors of intraoperative bleeding in CSP patients. Conclusion Embryonic cardiac beating and long operation time are independent risk factors for increased intraoperative blood loss in CSP patients. Therefore, it is recommended that patients with scar pregnancy should be diagnosed and treated early, and the skilled operative operators should be selected during surgical treatment to shorten the operation time as far as possible.