凶险性前置胎盘并胎盘植入产妇实施复合手术室治疗的临床效果研究

Clinical effect of combined operating room therapy for dangerous placenta previa and placenta-implanted parturients

目的研究复合手术室治疗凶险性前置胎盘并胎盘植入产妇的临床效果。方法将2017年4月—2019年4月75例凶险性前置胎盘并胎盘植入产妇按照随机数字表法分为两组,对照组37例接受直接剖宫产手术治疗,观察组38例接受复合手术室治疗,比较治疗效果。结果观察组子宫切除率为5.26%,低于对照组(24.32%),差异有统计学意义(χ2=5.442,P=0.020),观察组术中出血量、术中输血量、术后24 h阴道出血量均少于对照组,差异有统计学意义(t=7.287、30.721、20.682,P<0.01)。观察组术后24 h凝血酶原时间(PT)、凝血酶时间(TT)水平与组内术前比较,差异无统计学意义(P>0.05),对照组术后24h与组内术前比较明显下降,差异有统计学意义(P<0.05),观察组术后24h PT、TT水平高于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率为13.16%,低于对照组(32.43%),差异有统计学意义(χ2=3.973,P<0.05),观察组术后子宫复旧率为86.84%,高于对照组(64.86%),差异有统计学意义(χ2=4.964,P<0.05)。观察组新生儿出生后1、5、10 min的Apgar评分均高于对照组,差异有统计学意义(t=3.136、8.970、26.281,P<0.05)。结论对凶险性前置胎盘并胎盘植入产妇实施复合手术室治疗可有效减少术中出血,减低子宫切除率,减少术后并发症,加快子宫复旧,减低新生儿窒息风险。

Objective To study the clinical effect of compound operating room in treatment of dangerous placenta previa with placental implantation in puerpera.Methods From April 2017 to April 2019, Totally 75 women with dangerous placenta previa and placenta implantation were divided into two groups according to the random number table method. Totally 37 women in the control group received direct cesarean section, and 38 women in the observation group received complex operating room treatment, and the treatment effect was compared.Results The hysterectomy rate of the observation group was 5.26%, lower than that of the control group(24.32% χ~2=5.442, P=0.020). The intraoperative blood loss, intraoperative blood transfusion, and vaginal bleeding 24 h after operation of the observation group were all lower than those of the control group(t=7.287, 30.721, 20.682, P<0.01). The levels of PT and TT of the observation group were not significantly changed 24 h after surgery compared with those of the control group(P>0.05);The levels of PT and TT of the observation group were significantly decreased 24 h after surgery compared with those of the control group(P<0.05);The levels of PT and TT of the observation group were higher than those of the control group(P<0.05). The incidence of postoperative complications of the observation group was 13.16%, lower than that of the control group 32.43%(χ~2=3.973, P<0.05), and the rate of postoperative uterine recurrence of the observation group was 86.84%, higher than that of the control group(χ~2=4.964, P<0.05). Apgar score of newborns of the observation group was higher than that of the control group at 1 min, 5 min and 10 min after birth(t=3.136, 8.970 and 26.281, P<0.05).Conclusion Combined operating room treatment for dangerous placenta previa with placenta implantation can effectively reduce intraoperative bleeding, reduce uterine resection rate, reduce postoperative complications, accelerate uterine recovery, and reduce the risk of neonatal asphyxia.