双侧髂内动脉置管联合剖宫产术对凶险性前置胎盘合并胎盘植入患者应激状态、子宫切除及新生儿影响

Influence of bilateral internal iliac artery catheterization combined with cesarean section for treating patients with dangerous placenta previa and placenta implantation on their stress status,hysterectomy and neonates situations

目的:探讨双侧髂内动脉置管联合剖宫产术对凶险性前置胎盘合并胎盘植入患者应激状态、子宫切除率及新生儿Apgar评分的影响。方法:回顾性收集2018年6月-2019年12月本院接收治疗的凶险性前置胎盘合并胎盘置入103例临床资料,按照治疗方法的不同分为观察组(57例)和对照组(46例)。对照组采取常规止血措施联合剖宫产治疗,观察组采取双侧髂内动脉置管联合剖宫产治疗,对比两组术中应激反应水平、手术情况、并发症及子宫切除率、新生儿出生Apgar评分。结果:对照组手术时间、术中出血量、术中输血量、术后24h出血量(158.75±23.56 min)、(2870.24±366.28 ml)、(14.03±5.34 U)、(1106.73±320.34ml)等均高于观察组(130.65±17.53 min)、(1776.34±210.24ml)、(6.33±2.78 U)、(908.34±135.25 ml),术中心率(HR)(106.34±12.45次/min)、动脉压(MAP)(93.45±7.89mmHG)、血清皮质醇(Cor)(88.43±7.19pg/ml)、促肾上腺皮质激素(ACTH)(32.17±6.78ng/L)、肾上腺素(E)(195.38±20.46ng/ml)均高于观察组(84.56±5.43次/min)、(79.28±6.23 mmHG)、(36.75±5.22 pg/ml)、(13.56±3.21 ng/L)、(67.81±10.22 ng/ml),子宫切除率(19.6%,9例)、术后并发症率(32.6%,15例)高于观察组(5.3%,3例)、(10.5%,6例)(P<0.05);两组新生儿出生1min、5min Apgar评分无差异(P>0.05)。结论:双侧髂内动脉置管联合剖宫产术治疗对凶险性前置胎盘合并胎盘植入患者的术中应激反应更小、手术效果更佳,能降低子宫切除率,改善母婴结局。

Objective:To investigate the influence of bilateral internal iliac artery catheterization combined with cesarean section for treating patients with dangerous placenta previa and placenta implantation on their stress status and hysterectomy rate,and Apgar score of neonates.Methods:The clinical data of 103 pregnant women with dangerous placenta previa and placenta implantation from June 2018 to December 2019 were collected retrospectively.These women were divided into observation group(57 Cases)and the control group(46 cases)according to different treatment methods.The women in the control group were given conventional hemostasis measures combined with cesarean section treatment,and the women in the observation group were given bilateral internal iliac artery catheterization combined with cesarean section treatment.The intraoperative stress response level,surgical status,and the complications and hysterectomy rates of the women,and Apgar scores of the newborns were compared between the two groups.Results:The operative time,intraoperative blood loss,intraoperative blood transfusion,24h postoperative blood loss of the women in the control group were 158.75±23.56min,2870.24±366.28ml,14.03±5.34U,and 1106.73±320.34ml,which were significant higher than those(130.65±17.53min,1776.34±210.24ml,6.33±2.78U,and 908.34±135.25ml)of the women in the observation group.The HR(106.34±12.45 times/min),MAP(93.45±7.89 mmHG),serum cortisol(Cor)level(88.43±7.19 pg/ml),adrenocorticotrophic hormone(ACTH)level(32.17±6.78 ng/L),epinephrine(E)level(195.38±20.46ng/ml)of the women in the control group were significant higher than those(84.56±5.43times/min,79.28±6.23 mmHG,36.75±5.22 pg/ml,13.56±3.21 ng/L,and 67.81±10.22 ng/ml)of the women in the observation group.The hysterectomy rate(19.6%,9 cases),and postoperative complication rate(32.6%,15 cases)of the women in the control group were significant higher than those(5.3%,3 cases,and 10.5%,6 cases)of the women in the observation group(P>0.05).There were no significant differences in Apgar score of newborns at 1min and 5min after born between the two groups(P>0.05).Conclusion:The treatment of bilateral internal iliac artery catheterization combined with cesarean section for treating patients with dangerous placenta previa combined with placenta implantation has less intraoperative stress response,and has better surgical effectiveness,which can reduce the hysterectomy rate and can improve maternal and infant outcomes.