凶险性前置胎盘产妇介入手术治疗及围术期输血情况分析

Interventional surgery treatment and perioperative blood transfusion for maternal with pernicious placenta previa

目的探讨凶险性前置胎盘应用不同介入手术治疗方式及其在这类产妇血液管理中的价值。方法收集本院产科2015—2018年住院分娩的140名凶险性前置胎盘产妇的临床资料,根据剖宫产术中不同的介入方式分为子宫动脉栓塞术组(n=34)和腹主动脉球囊阻断术(n=106)。回顾性比较分析2组产妇的基本资料、术中出血量、产后24 h出血量、围术期成分血输注量、新生儿Apgar评分及体重。结果子宫动脉栓塞组和腹主动脉球囊阻断组,输血率为94.1%(32/34)vs 50%(53/106)(P<0.05),大量输血率为44.1%(15/32)vs 7.5%(8/106)(P<0.05);产后出血率为85.2%(29/34)vs 55.7%(59/106)(P<0.05);子宫切除率为14.7%(5/34)vs 2.8%(3/106)(P<0.05);术中出血量(mL)为2 000(800,3 250)vs 800(500,1 200)(P<0.05);围术期红细胞、血浆、冷沉淀、血小板的人均用血量(U)分别为11.6±12.0 vs 2.6±4.1、9.0±10.2 vs 2.6±3.8、5.6±9.6 vs 0.6±2.3、4.1±11.3 vs 0.6±2.3(P<0.05)。结论腹主动脉球囊阻断术较子宫动脉栓塞术能更有效控制术中出血量,减少产后出血和围术期异体血的输注,降低子宫切除率,有益于实施凶险性前置胎盘产妇的血液管理。

Objective To analyze two interventional methods for the treatment of pernicious placenta previa,and to explore their value in blood management.Methods Clinical data of 140 patients with pernicious placenta previa from 2015 to 2018 submitted to our hospital were collected,and divided into uterine artery embolization group(n=34)and abdominal aorta balloon occlusion group(n=106)according to different interventional methods in cesarean section.Such data as basic information,intraoperative blood loss,24 h postpartum blood loss,perioperative component blood transfusion,newborn′s Apgar score and birth weight of two groups were retrospectively analyzed and compared.Results In the uterine artery embolization group and the abdominal aortic balloon occlusion group,the incidence of transfusion was 94.1%(32/34)vs 50%(53/106)(P<0.05);the incidence of massive blood transfusion was 44.1%(15/32)vs 7.5%(8/106)(P<0.05);the incidence of postpartum hemorrhage was 85.2%(29/34)vs 55.7%(59/106)(P<0.05);the hysterectomy rate was 14.7%(5/34)vs 2.8%(3/106)(P<0.05);the intraoperative blood loss was 2000 mL(800,3250)vs 800 mL(500,1200)(P<0.05).The total transfusion units(U)of red blood cells,plasma,cryoprecipitate and platelets of the two groups were 11.6±12.0 vs 2.6±4.1,9.0±10.2 vs 2.6±3.8,5.6±9.6 vs 0.6±2.3,4.1±11.3 vs 0.6±2.3(P<0.05).Conclusion Abdominal aortic balloon occlusion incurs supreior outcome in controlling intraoperative blood loss,reducing postpartum hemorrhage and perioperative blood transfusion,as well as minimizing the rate of hysterectomy as compared with uterine artery embolization,and was beneficial to a better blood management for patients with pernicious placenta previa.