超声监测在前置胎盘剖宫产术液体治疗中的作用分析

Analysisof the role of ultrasonic monitoring in fluid treatment of placenta previa cesarean section

目的 探讨超声监测在前置胎盘剖宫产术液体治疗中的作用。方法 选取2020年3月至2021年9月在南京市高淳人民医院因前置胎盘行剖宫产术且发生术中出血的80例患者作为研究对象,根据不同的液体治疗方案将患者分为观察组(n=42)与对照组(n=38),其中给予对照组常规补液治疗,给予观察组目标导向液体治疗;比较两组不同时间点[手术前(T0)、麻醉后(T1)、胎儿娩出(T2)、剥离胎盘(T3)、术毕(T4)]的血流动力学指标,以及出血量、补液量、凝血功能的变化和术后并发症的发生情况,并进行统计分析。结果 (1)观察组与对照组的心率(HR)均在T3时达到最高值[(91.56±12.43)次/分vs.(90.28±12.86)次/分];观察组T2、T3时的平均动脉压(MAP)均显著高于对照组,差异均有统计学意义(t值分别为2.117、2.689,P<0.05),且观察组与对照组的MAP均在T3时达到最低值[(76.12±10.47)mmHg vs.(70.29±8.73)mmHg];观察组T3时的CVP显著低于对照组,差异有统计学意义(t=2.370,P<0.05),且观察组与对照组的CVP均在T3时达到最高值[(9.51±2.46)mmHg vs.(10.92±2.86)mmHg];观察组T3、T4时的CI均显著高于对照组,差异均有统计学意义(t值分别2.051、2.013,P<0.05)。(2)观察组术中的出血量、晶体液输液量、悬浮红细胞输入量、去甲肾上腺素用量均显著低于对照组,低血压发生率也显著低于对照组,差异均有统计学意义(t值分别为3.926、4.084、5.081、7.461;χ^(2)=6.023,P<0.05)。(3)凝血功能情况:观察组T0时的凝血酶时间(TT)显著长于对照组,差异有统计学意义(t=2.083,P<0.05);观察组T4时的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、TT均显著短于对照组,纤维蛋白原(FIB)显著高于对照组,差异均有统计学意义(t值分别为14.956、6.363、11.505、2.857,P<0.05)。(4)术后并发症情况:观察组术后并发症总发生率显著低于对照组,差异有统计学意义(χ^(2)=4.941,P<0.05)。结论 超声监测在前置胎盘剖宫产术液体治疗中有利于患者血流动力学指标的稳定,降低手术过程中的输液量和输血量,改善其凝血功能,安全性较高。

Objective To investigate the application of ultrasonic monitoring in fluid treatment of placenta previa cesarean section.Methods A total of 80 patients who underwent caesarean section due to placenta previa and suffered intraoperative hemorrhage in Nanjing Gaochun People's Hospital from March 2020 to September 2021 were selected as the research objects.According to the different fluid rehydration schemes,they were divided into the observation group(n=42) and the control group(n=38).The control group was given routine rehydration therapy,the observation group was given goal-oriented fluid therapy,and the hemodynamic indicators of two groups were compared at different time points [before surgery(T0),after anesthesia(T1),fetal delivery(T2),detached placenta(T3),after surgery(T4)],blood loss,fluid supplementation,changes in blood coagulation function and the occurrence of postoperative complications were compared,and statistical analysis was performed.Results(1)The heart rate(HR) of observation group and control group reached the highest value at T3 [(91.56±12.43) times/min vs.(90.28±12.86) times/min].The mean arterial pressure(MAP) of the observation group at T2 and T3 was significantly higher than that of the control group,and the differences were statistically significant(t =2.117 and 2.689,respectively,P<0.05),and the MAP of the observation group and the control group reached the lowest value at T3 [(76.12±10.47) mmHg vs.(70.29±8.73) mmHg].The CVP of the observation group at T3 was significantly lower than that of the control group,the difference was statistically significant(t=2.370,P<0.05),and the CVP of both the observation group and the control group reached the highest value at T3 [(9.51±2.46) mmHg vs.(10.92±2.86) mmHg].CI at T3 and T4 in the observation group was significantly higher than that in the control group,with statistical significance(t = 2.051 and 2.013,respectively,P<0.05).(2)The amount of intraoperative blood loss,crystalloid fluid infusion,suspended red blood cell input and dosage of norepinephrine in the observation group were significantly lower than those in the control group,and the incidence of hypotension was also significantly lower than that in the control group,with statistical significance(t=3.926,4.084,5.081 and 7.461,respectively.χ^(2)=6.023,P<0.05).(3)Coagulation function:thrombin time(TT) at T0 in observation group was significantly longer than that in control group,the difference was statistically significant(t=2.083,P<0.05).The prothrombin time(PT),activated partial thromboplastin time(APTT) and TT of the observation group at T4 were significantly shorter than those of the control group,while the fibrinogen(FIB) of the observation group was significantly higher than that of the control group,with statistical significance(t=14.956,6.363,11.505 and 2.857,respectively,P<0.05).(4)Postoperative complications:the total incidence of postoperative complications in the observation group was significantly lower than that in the control group,the difference was statistically significant(χ^(2)=4.941,P<0.05).Conclusion Ultrasound monitoring in fluid treatment of placenta previa cesarean section is beneficial to the stability of the patient's hemodynamic indicators,reduce the amount of blood transfusion and infusion during the operation,and improve the blood coagulation function,and has a high safety profile.