超声评分结合预防使用卡前列氨丁三醇、宫颈提拉式缝合在前置胎盘植入的应用

Application of ultrasound score combined with prophylactic use of Carboprost tromethamine and cervical pull-up suture in placenta previa implantation

目的探讨超声评分结合前置胎盘、胎盘植入术中预防使用卡前列氨丁三醇、宫颈提拉式缝合的止血效果。方法选择2017年1月—2021年12月在本院产科住院手术的前置胎盘、胎盘植入患者80例为研究对象,按手术前是否使用超声评分分为观察组(使用超声评分)和对照组(未使用超声评分)两组,每组各40例。分析超声评分是否有临床应用价值,预防使用卡前列氨丁三醇,或采取宫颈提拉式缝合,对降低前置胎盘、胎盘植入术中出血是否有效。观察组中21例预防使用卡前列氨丁三醇,14例采取宫颈提拉式缝合与对照组中33例未预防使用卡前列氨丁三醇,38例未采取宫颈提拉式缝合进行比较。记录胎盘植入是否与超声评分相符,记录两组终止妊娠时间、术中出血量、产后出血率、输血率、子宫切除率等方面的差异。结果通过超声评分检出粘连型33例,植入型2例,另4例为植入型误断为粘连型,穿透型1例(未穿透浆膜层属植入型),准确率87.5%;超声评分对诊断粘连型或无植入型的准确率较高,诊断植入型和穿透型的准确率较低。观察组孕37周后终止妊娠者23例,对照组24例,说明超声评分对终止时机无影响;观察组患者术中平均出血量明显低于对照组,差异有统计学意义(P<0.05);观察组患者的产后出血发生率明显低于对照组,差异有统计学意义(P<0.05);两组患者的输血率、子宫切除率比较,差异无统计学意义(P>0.05)。结论前置胎盘、胎盘植入患者使用超声评分不会影响终止妊娠时机,利用它合理术前准备,有效降低子宫切除和DIC风险,减少术中出血,改善患者不良结局,有一定的临床应用价值。结合预防使用卡前列氨丁三醇,根据子宫出血情况采取宫颈提拉式缝合可快速有效止血,降低产后出血,明显改善患者预后。

Objective To investigate the hemostatic effect of ultrasound scorecombined with prophylactic use of carboprost tromethamine and cervical pull suture during placenta previa and placenta implantation.Methods 80 inpatients with placenta previa and placental implantation those were admitted to Wuhu second people's hospital from January 2017 to December 2021 and received surgery were selected as the research objects,according to the utilize of ultrasonic score they were divided into observation group(adopted ultrasonic score)and control group(did not adopted ultrasonic score),40 cases in each group.We aimed to analyze whether the ultrasonic score has clinical application value,whether the prophylactic use of carboprostaglandin or cervical pull-up suture is effective in reducing the bleeding during the operation of placenta previa and placental implantation.The 21 cases were givenprophylactic use of carboprost tromethamine and 14 cases were treated with cervical pull-up type suture in the observation group were compared to the 33 cases those did not received prophylactic use of carboprost tromethamine and 38 cases did not been treated with cervical pull-up type suture in the control group.Record whether placenta implantation is consistent with ultrasound score,and record the differences in termination of pregnancy time,intraoperative bleeding,postpartum bleeding rate,blood transfusion rate and hysterectomy rate between the two groups.Results 33 cases of adhesion type and 2 cases of implantation type were identified in the observation group,with an accuracy rate of 87.5%.Thee were 4 cases of implant type were misdiagnosedas adhesion type,and 1 case was penetration type(not penetrating serosal layer belongs to implant type).The accuracy of ultrasound score was higher in the diagnosis of adhesion type or non-implants,but lower in the diagnosis of implant type and penetration type.There were 23 cases of termination of pregnancy after 37 weeks in the observation group and 24 cases in the control group,indicating that the ultrasonic score had no effect on the timing of termination.The average intraoperative bleeding and postpartum bleeding rate in the observation group were lower than those in the control group(P<0.05).There was no significant difference in blood transfusion rate and hysterectomy rate(P>0.05).Conclusions The use of ultrasound score in patients with placenta previa and placental implantation will not affect the timing of termination of pregnancy.Utilize it to make reasonable preoperative preparation could effectively reduce the risk of hysterectomy and DIC,reduce intraoperative bleeding and improve the adverse outcome of patients.It has a certain clinical application value.Combined with prophylactic use of carboprost tromethamine and cervical pull-up type suture according to the situation of uterine bleeding could quickly and effectively stop bleeding,reduce postpartum hemorrhage and significantly improve the prognosis of patients.