不同型号腹主动脉球囊在凶险性前置胎盘患者应用的疗效分析

Clinical Effect Analysis of Different Types of Abdominal Aortic Balloon in Patients with Pernicious Placenta Previa

目的:评价不同型号腹主动脉球囊阻断术在凶险性前置胎盘患者中的应用价值。方法:回顾性分析2013年1月至2019年12月因术前术后均诊断为凶险性前置胎盘而于四川省人民医院产科行术前腹主动脉球囊阻塞后立即剖宫产的177例患者的临床资料。将不同型号的腹主动脉球囊的患者分为大球囊组109例,小球囊组68例。比较两组患者术中情况、治疗情况、导管相关并发症及治疗、围产儿结局等指标的差异。结果:(1)两组孕妇在剖宫产术中手术持续时间、预估出血量、输血率、手术前后血红蛋白差、术中子宫切除率等方面差异均无统计学意义(P>0.05)。(2)两组孕妇在术后住院时间、住院费用的比较,小球囊组均少于大球囊组,差异有统计学意义(P<0.05)。(3)小球囊组的导管并发症发生率、下肢动脉栓塞发生率、手术联合抗凝治疗率均少于大球囊组,差异有统计学意义(P<0.05)。(4)两组在早产率、新生儿窒息率、围产儿存活率比较差异均无统计学意义(P>0.05)。结论:小球囊腹主动脉球囊阻断术在凶险性前置胎盘患者的术中不增加出血量、子宫切除率及围产儿不良结局,并有助于减少球囊导管并发症的发生,降低住院费用和术后住院时间。

Objective:To evaluate the value of different types of abdominal aorta balloon block in patients with pernicious placenta previa.Methods:The clinical data of 177 patients confirmed with pernicious placenta previa before and after operation who underwent cesarean section immediately after preoperative abdominal aorta balloon block in the obstetrics department of Sichuan Provincial People′s Hospital from January 2013 to December 2019 was retrospectively analyzed.The patients received different types of abdominal aortic balloon were divided into large balloon group(109 cases)and small balloon group(68 cases).The intraoperative condition,treatments,catheter-related complications as well as its treatment and perinatal outcomes between the two groups were compared.Results:(1)There was no significant difference in operation duration,estimated blood loss,blood transfusion rate,hemoglobin difference before and after operation,hysterectomy rate between the two groups(P>0.05).(2)Postoperative hospitalization time was shorter and hospital cost was less in the small balloon group than those in the large balloon group,and the differences were significant(P<0.05).(3)The incidence rates of catheter-related complications,lower extremity arterial embolism and operation combined with anticoagulant therapy in the small balloon group were significantly lower than those in the large balloon group(P<0.05).(4)There were no significant differences in premature birth rate,neonatal asphyxia rate or perinatal survival rate in the two groups(P>0.05).Conclusions:Small balloon abdominal aortic balloon block does not increase the amount intraoperative bleeding,hysterectomy rate and adverse perinatal outcomes in patients with pernicious placenta previa,and helps to reduce the occurrence of balloon catheter-related complications,hospital costs and postoperative hospital stay.