胎盘植入性疾病735例临床分析

Clinical analysis of 735 cases of placenta accreta disease

目的探讨不同类型胎盘植入性疾病(PAS)及不同止血方式对妊娠结局的影响。方法回顾性分析735例不同类型及不同妊娠合并疾病PAS患者产后24小时出血量;产后出血、子宫切除及血制品输注等不良妊娠结局发生率;住院期间最低血红蛋白浓度及住院天数之间的差异。并分析不同止血方式产后24小时出血量的差异。结果①PAS合并内科疾病患者产后出血发生率、血液制品输注率及住院时长均高于PAS合并产科疾病者,而住院期间最低血红蛋白浓度低于PAS合并产科疾病者(P<0.05);同时患有两类疾病患者住院时间更长(P<0.05);②药物止血及多种方式联合止血组产后24小时出血量低于未使用组(P<0.05);经导管动脉栓塞术组产后24小时出血量与未使用组比较差异无统计学意义(P>0.05);球囊填塞组产后24小时出血量高于未使用组(P<0.05)。结论相较于PAS合并产科疾病,PAS合并内科疾病的产妇不良妊娠结局更差,推荐早期使用药物止血或联合止血方式控制出血。

Objective To investigate the effects of different types of placenta accreta disease(PAS)and different hemostasis methods on pregnancy outcomes.Methods Clinical data of the 24-hour postpartum hemorrhage volume in 735 patients with different types and different pregnancy-related diseases of PAS,the incidence of adverse pregnancy outcomes such as postpartum hemorrhage,hysterectomy,and blood product infusion,the differences between the lowest hemoglobin concentration during hospitalization and the length of hospitalization were compared.The differences of 24 hours postpartum hemorrhage were also compared among different hemostatic methods.Results The incidence of postpartum hemorrhage,transfusion rate of blood products and length of hospital stay were higher while the lowest hemoglobin concentration during hospitalization was lower in the PAS patients with internal diseases than those in the PAS patients with obstetric diseases(P<0.05).Patients with both diseases had longer hospitalization(P<0.05).The amount of 24 h postpartum bleeding in the group with drug hemostasis or combined hemostasis in multiple ways was lower than that in the non-use group(P<0.05).There was no significant difference in amount of 24 h postpartum bleeding between the transcatheter arterial embolization group and the non-use group(P>0.05).The amount of 24 h postpartum bleeding in the balloon tamponade group was higher than that in the non-use group(P<0.05).Conclusion Compared with PAS combined with obstetric disease,maternal adverse pregnancy outcome of PAS combined with internal medical disease is worse.It recommends to early use of drug hemostasis or combined hemostasis to control bleeding.