防波堤样缝合对前置胎盘伴胎盘植入患者止血效果、新生儿结局的影响

Effect of breakwater suture on hemostatic effect and neonatal outcome of patients with placenta previa and placenta implantation

目的 探究防波堤样缝合对前置胎盘(PP)伴胎盘植入(PA)患者止血效果、新生儿结局的影响。方法 选择我院收治的PP伴PA患者70例,按止血方案不同分观察组和对照组。每组35例。观察组接受防波堤样缝合止血,对照组接受局部“8”字缝扎止血。对比两组围术期指标(术中失血量、术后2 h失血量、手术用时)、术后恢复指标(月经恢复时间、恶露持续时间、术后1 d恶露量)、手术前后凝血功能[D二聚体(D-D)、纤维蛋白原(FIB)、凝血酶原时间(PT)、凝血酶时间(TT)]、应激反应[肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)]水平、新生儿结局(Apgar评分、新生儿体重)。结果 观察组术中及术后2 h失血量相较于对照组更低(P<0.05)。观察组月经恢复及恶露持续时间相较于对照组更短,术后1 d恶露量相较于对照组更少(P<0.05)。观察组术后24 h PT、TT相较于对照组更短,FIB、D-D水平相较于对照组更高(P<0.05)。观察组术后24 h血清NE、E、Cor水平相较于对照组更低(P<0.05)。两组手术时间、Apgar评分和出生时体重比较,P>0.05。结论 PP伴PA患者经防波堤样缝合与局部“8”字缝扎止血均具有良好新生儿结局,但前者能进一步提升止血效果、促进凝血功能改善、缩短患者术后恢复进程、降低对机体术后应激反应的影响。

Objective To explore the effect of breakwater suture on hemostatic effect and neonatal outcome of patients with placenta previa(PP)and placenta implantation(PA).Methods 70 patients with PP combined with PA admitted to our hospital were randomly divided into two groups according to different hemostatic methods.Thirty-five patients in the observation group received breakwater suture,and 35 patients in the control group received local"8"suture for hemostasis.The perioperative indexes(intraoperative blood loss,2 h postoperative blood loss,operation time),postoperative recovery indexes(menstrual recovery time,lochia duration,1d postoperative lochia volume),coagulation function before and after operation[D-dimer(D-D),fibrinogen(FIB),prothrombin time(PT),thrombin time(TT)],stress response levels[epinephrine(E),norepinephrine(NE),cortisol(Cor)],neonatal outcomes(Apgar score,neonatal weight)were compared between the two groups.Results The intraoperative and 2h postoperative blood loss in the observation group was lower than that in the control group(P<0.05).The menstrual recovery time and lochia duration time in the observation group were shorter than those in the control group,and the amount of lochia one day after surgery was less than that in the control group(P<0.05).1d after surgery,the PT and TT in the observation group were shorter,the FIB and D-D levels were higher than those in the control group(P<0.05).The levels of serum NE,E and Cor in the observation group were lower than those in the control group 24h after operation(P<0.05).There were no significant differences in operation time,Apgar score and birth weight between the two groups(P>0.05).Conclusion The breakwater suture and local"8"suture both has good effect on neonatal outcome,but the former can further improve the hemostasis effect,promote the improvement of coagulation function,shorten the postoperative recovery process,and reduce the influence on the postoperative stress response of the body.