腹主动脉球囊阻断组合式止血方法在中央型前置胎盘合并胎盘植入的剖宫产术中的应用效果

摘要

目的 探讨腹主动脉球囊阻断组合式止血方法在中央型前置胎盘合并胎盘植入的剖宫产术中的应用效果及价值.方法 回顾性分析2007年3月至2018年8月在大连医科大学附属妇产医院暨大连市妇幼保健院住院并行剖宫产分娩的47例中央型前置胎盘合并胎盘植入的产妇的临床资料,其中17例产妇行子宫下段剖宫产术前行腹主动脉球囊预置组合式止血方法(研究组),另外30例仅行子宫下段剖宫产术及其他止血方法(对照组).比较两组产妇手术时间、术中出血量、术中输血量、弥散性血管内凝血(DIC)发生率、子宫切除率及术后并发症、术后住院时间、术后24 h凝血功能指标(活化部分凝血酶原时间、纤维蛋白原、D-二聚体)等.结果 研究组和对照组的术中出血量[1 000(800~2 000)ml,2 200(1 000~4 100)ml]、术中总输血量[400(0~2 450)ml,2 460(200~4 460 ml)]比较差异均有统计学意义(Z=—2.272,P=0.023;Z=—2.02,P=0.030).研究组释放球囊恢复血流后有16例患者仍有较多出血,1例宫腔球囊压迫后血止,其余15例行子宫动脉结扎术,11例患者同时行宫腔球囊压迫术,1例妊娠28+周患者因胎盘植入膀胱、失血性休克伴DIC行次全子宫切除;对照组30例患者中有7例因失血性休克伴或不伴DIC行全子宫切除,3例因大量产后出血行次全子宫切除术,两组的子宫切除率比较[1/17比33.3% (10/30)],差异有统计学意义(P=0.039).结论 腹主动脉球囊阻断术结合传统止血方法可以减少中央型前置胎盘合并胎盘植入的剖宫产术中出血量及术中输血量,降低子宫切除率.%Objective To investigate the value of abdominal aortic balloon combined homeostasis in the cesarean section with invasive completeplacenta previa. Methods Data of 47 cases of completeplacenta previa with placenta accrete from March 2007 to August 2018 were analyzed retrospectively. Seventeen cases (study group) were treated with abdominal aortic balloon combined homeostasis before cesarean, and 30 cases (control group) did not receive balloon occlusion. The operation time, intra-operative blood loss, intra-operative blood transfusion volume, disseminated or diffuse intravascular coagulation (DIC) rate, hysterectomy rate and post operative complications, time of postoperative hospital stay were compared. Also, the blood coagulation parameters 24 h after operation, including activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer werecompared between the two groups. Results Significant difference was observed in the blood loss [1 000 (800—2 000) ml vs. 2 200 (1 000-4 100) ml, Z=-2.272, P=0.023] and blood transfusion volume [400 (0-2 450) ml vs. 2 460 (200-4 460) ml, Z =- 2.02, P = 0.03], 16 cases of the study group still bled after releasing the balloon.Fifteen cases of them received uterine artery ligation. Bleeding stopped after uterine balloon compression in 1 case. Eleven cases of the 15 cases received uterine balloon compression at the same time. One case of 28 weeks gestation underwent subtotal hysterectomy due to hemorrhagic shock combined with DIC caused by placenta accretion of the bladder. While in control group, 7 cases underwent total hysterectomy because hemorrhagic shock combined with DIC and 3 cases underwent subtotal hysterectomy due to heavy bleeding, and there was statistical significance between two groups [1/17 vs. 33.3%(10/30), P=0.039]. Conclusions Temporary balloon occlusion of the abdominal aorta combined with conventional homeostasis can reduce blood loss, blood transfusion and hysterectomy rate in the cesarean section complicated with invasive complete placenta previa.