多学科协作行腹主动脉球囊阻断在凶险性前置胎盘并胎盘植入患者剖宫产术中的临床应用的研究

Multidisciplinary collaboration in abdominal aortic balloon occlusion during cesarean section of patients with placenta previa and placental implantation

目的探讨多学科协作在杂交手术室行腹主动脉球囊阻断在凶险性前置胎盘并胎盘植入患者剖宫产术中的的临床应用的效果及安全性。方法选取2017年2月—2020年2月在平顶山市第一人民医院行剖宫产治疗前置胎盘伴胎盘植入的产妇89例,32例多学科协作在杂交手术室行剖宫产术,57例常规手术室直接行剖宫产术。根据手术方案将产妇分为观察组(32例)和对照组(57例),观察组剖宫产术前行腹主动脉球囊阻断术;对照组直接行剖宫产术。比较分析2组手术情况、术后并发症发生情况、新生儿健康情况。结果观察组手术出血量、术中输血量、手术时间及住院时间均少于对照组,差异具有统计学意义(t=20.581、20.645、5.345、3.399,P均<0.05)。观察组失血性休克、次全子宫切除及肾功能异常的发生率少于对照组,差异具有统计学意义(χ^(2)=2.739、5.148、4.954,P均<0.001),观察组术后感染、盆腔粘连的发生率与对照组比较差异无统计学意义(P>0.05)。观察组新生儿出生后1 min Apgar评分、5 min Apgar评分与对照组比较差异无统计学意义(P>0.05)。结论多学科协作在杂交手术室行腹主动脉球囊阻断术应用于凶险性前置胎盘并胎盘植入患者剖宫产术能够明显减少术中出血、次全子宫切除、缩短手术时间、减少术后并发症,且不影响新生儿健康情况。

Objective To investigate the clinical efficacy and safety of multidisciplinary collaboration in abdominal aortic balloon occlusion during cesarean section of patients with placenta previa and placenta accreta in hybrid operating rooms.Methods Between February 2017 and February 2020,89 cases of placenta previa with placenta accreta were selected.According to surgical approaches,the parturients were divided into the observation group(32 cases)and control group(57 cases).In the observation group,abdominal aortic balloon occlusion was performed before cesarean section while in the control group,cesarean section was performed directly.The complexity of operations,postoperative complications and neonatal health were compared between the two groups.Results The amount of bleeding,blood transfusion,duration of surgery,length of hospital stay in the observation group compared favorably with the control group(t=20.581,20.645,5.345,3.399,all P<0.05).The incidence of hemorrhagic shock,supracervical hysterectomy and renal dysfunction was significantly lower in the observation group than in the control group(χ^(2)=2.739,5.148,4.954,all P<0.001).There was no significant difference in the incidence of postoperative infections or pelvic adhesions between the two groups(P>0.05).Conclusion Multidisciplinary collaboration in abdominal aortic balloon occlusion during cesarean section of patients with placenta previa and placental implantation in hybrid operating rooms can significantly reduce the amount of intraoperative bleeding and incidence of supracervical hysterectomy,shorten hospital stay,mitigate postoperative complications,and ensure the health of newborns.