非顺应性腹主动脉球囊阻断术在凶险性前置胎盘伴胎盘植入剖宫产中的应用

Application of non-compliant balloon occlusion of abdominal aorta during cesarean section of pernicious placenta previa with placental implantation

目的探讨在辅助凶险性前置胎盘伴胎盘植入剖宫产的过程中,非顺应性腹主动脉球囊阻断术的临床应用价值。方法回顾性分析2020年6月至2022年9月在湖北省妇幼保健院收治的114例凶险性前置胎盘伴胎盘植入产妇的临床治疗,其中54例(A组)进行了非顺应性腹主动脉球囊阻断术,60例(B组)未行腹主动脉球囊阻断术。通过对比两组产妇的术中出血量、手术时长、术中收缩压波动幅度、手术前后收缩压及舒张压变化、术后住院天数、新生儿1 min及5 min Apgar评分等指标来评估非顺应性腹主动脉球囊阻断术在剖宫产术治疗凶险性前置胎盘的安全性及有效性。结果A组与B组两组产妇的年龄、孕次、剖宫产次、孕周均无统计学差异;胎盘植入类型分布有明显差异(Z=-2.980,P=0.003);产妇手术时长、子宫切除率、住院天数均无明显差异。A组中,胎盘粘连型(t=-2.250,P=0.032)、植入型(t=-2.230,P=0.030)、穿透型(t=-2.304,P=0.031)术中出血量均少于B组产妇;胎儿X线曝光时长为4~33 s,平均(12.20±6.74)s,X线曝光剂量为1.99~12.16 mGy,平均(4.65±2.61)mGy。两组新生儿娩出后1 min(P=0.420)及5 min(P=0.474)的Apgar评分无统计学差异。A组产妇术中收缩压波动(t=3.064,P=0.003)及舒张压波动(t=3.126,P=0.002)幅度明显大于B组产妇。两组产妇术后并发症发生率(下肢静脉血栓、动脉血栓、产褥期感染、主动脉损伤、术后心功能不全、产后出血)无明显差异(χ^(2)=0.057,P=0.852)。结论对于凶险性前置胎盘伴胎盘植入的产妇,在进行剖宫产的过程中,使用非顺应性腹主动脉球囊短时间内阻断腹主动脉血流能够安全、有效地减少术中出血量,且尚未发现对新生儿有明显损伤。

Objective To explore the clinical application value of non-compliant balloon occlusion of abdominal aorta during cesarean section of pernicious placenta previa with placental implantation.Methods A retrospective analysis was made on the clinical treatment data of 114 women with pernicious placenta previa and placental implantation admitted to Hubei Maternal and Children's Hospital from June 2020 to September 2022.Among them,54 cases(group A)underwent non-compliant abdominal aortic balloon occlusion,and 60 cases(group B)did not.The safety and effectiveness of non-compliant abdominal aortic balloon occlusion in the treatment of pernicious placenta previa during cesarean section was evaluated by comparing the intraoperative hemorrhage,the operation duration,the fluctuation of intraoperative systolic blood pressure,the changes of systolic and diastolic blood pressure before and after operation,the hospitalization days after cesarean section,and 1st and 5th minute Apgar score of newborns.Results There were no statistical differences in age,gestational times,cesarean section times and gestational weeks between group A and group B,and there was a significant difference in the type of placental implantation between the two groups(Z=-2.980,P=0.003).There were no significant differences in operation duration,hysterectomy rate and hospital stay.Compared with the two groups of parturient with placental implantation,the amount of intraoperative hemorrhage of placenta accrete(t=-2.250,P=0.032),placenta increta(t=-2.230,P=0.030)and placenta percreta(t=-2.304,P=0.031)in group A was less than that of group B.The fetal X-ray exposure duration in group A was 4~33 seconds,with an average of(12.20±6.74)seconds.The X-ray exposure dose was 1.99~12.16 mGy,with an average of(4.65±2.61)mGy.There was no significant difference in Apgar scores between the two groups at 1 minute(P=0.420)and 5 minutes(P=0.474)after delivery.The fluctuation of systolic blood pressure(t=3.064,P=0.003)and diastolic blood pressure(t=3.126,P=0.002)in group A were significantly greater than those in group B.There were no significant differences between the two groups in the incidence of postoperative complications(lower limb venous thrombosis,arterial thrombosis,puerperal infection,aortic injury,postoperative cardiac insufficiency,and postpartum hemorrhage)(χ^(2)=0.057,P=0.852).Conclusions For the pregnant women with pernicious placenta previa and placental implantation,during cesarean section,filling the non-compliant abdominal aortic balloon to block abdominal aortic blood flow temporarily can safely and effectively reduce the intraoperative hemorrhage,and no obvious damage to the newborns has been found.