不同腹主动脉阻断方式治疗植入型凶险性前置胎盘效果观察

Comparison on Effect of Different Intraoperative Aorta Occlusion Methods in the Treatment of Implantable Pernicious Placenta Previa

目的:探讨凶险性前置胎盘(PPP)伴胎盘植入患者采用不同腹主动脉球囊预置术(IABO)的效果。方法:回顾性分析98例PPP伴胎盘植入患者的临床资料,其中对照组42例,采用IABO连续性阻断主动脉方案,观察组56例,采用IABO间歇性阻断主动脉方案;采用倾向性评分匹配分析患者基线资料,采用近邻法进行1∶1匹配,经倾向性评分匹配后,最终纳入观察组、对照组病例各30例;统计2组临床指标(住院时间、术中出血量、输血量及手术时间),采用阿普加(Apgar)评分评估新生儿健康情况,对2组并发症、子宫切除情况进行统计。结果:观察组术中出血量[(1108.45±200.13)vs(1122.35±230.12)mL]、手术时间[(125.31±18.62)vs(124.30±19.41)min]、住院时间[(8.83±2.20)vs(8.52±2.30)d]及输血量[(2.40±0.52)vs(2.28±0.45)U]与对照组比较,差异无统计学意义(P>0.05);观察组新生儿1 min、5 min Apgar评分[(7.32±1.35)vs(7.21±1.37)分,(8.01±0.98)vs(7.85±1.04)分]与对照组比较,差异无统计学意义(P>0.05);观察组动脉血栓发生率(10.00%vs 33.33%)、下肢感觉障碍发生率(6.67%vs 36.67%)低于对照组(P<0.05);观察组子宫切除率与对照组比较差异无统计学意义(13.33%vs 20.00%,P>0.05)。结论:PPP伴胎盘植入患者采用IABO间歇性、连续性阻断主动脉方案均有较好临床效果,其中IABO间歇性阻断主动脉可减少并发症发生。

Objective:To investigate the effect of different intraoperative aorta balloon occlusion(IABO)schemes in patients with pernicious placenta previa(PPP)with placental implantation.Methods:The clinical data of 98 patients with pernicious placenta previa complicated by placental implantation treated in the hospital from January 2019 to June 2020 were analyzed retrospectively,of which 42 cases in the control group were continuously blocked by IABO;56 cases in the observation group were intermittently blocked by IABO,the baseline data of patients were analyzed by propensity score matching,the nearest neighbor method was used for 1:1 matching,30 cases each were finally included into the observation group and the control group.The clinical indexes of the two groups(hospitalization time,intraoperative blood loss,blood transfusion volume and operation time)were counted,and the Apgar score was used to assess the health of the newborn,and the complications and hysterectomy were counted.Results:The intraoperative bleeding volume[(1108.45±200.13)vs(1122.35±230.12)mL],operation time[(125.31±18.62)vs(124.30±19.41)min],hospitalization time[(8.83±2.20)vs(8.52±2.30)d]and blood transfusion volume[(2.40±0.52)vs(2.28±0.45)U]in the observation group were compared with those in the control group,the differences were not statistically significant(P>0.05);Apgar scores at 1 min and 5 min in the observation group[(7.32±1.35)vs(7.21±1.37),(8.01±0.98)vs(7.85±1.04)]were compared with those in the control group,there was no statistically significant difference(P>0.05);the incidence of arterial thrombosis(10.00%vs 33.33%)and sensory disturbance of lower limbs(6.67%vs 36.67%)in the observation group was lower than that in the control group(P<0.05);the hysterectomy rate in the observation group was 13.33%,compared with 20.00%in the control group,there was no statistically significant difference(P>0.05).Conclusion:Both IABO intermittent and continuous aortic occlusion have a better effect on patients with PPP and placental implantation,of which IABO intermittent aortic occlusion can reduce the occurrence of complications.