文章摘要
折开娥,张凌燕,李 虹,秦 利,吴桂清.腹动脉球囊置入联合宫颈提拉缝合治疗凶险性前置胎盘产后大出血临床效果[J].,2022,(20):3917-3921
腹动脉球囊置入联合宫颈提拉缝合治疗凶险性前置胎盘产后大出血临床效果
Clinical Effect of Abdominal Artery Balloon Implantation Combined with Cervical Pull Suture in the Treatment of Dangerous Postpartum Hemorrhage of Placenta Previa
投稿时间:2022-03-11  修订日期:2022-04-07
DOI:10.13241/j.cnki.pmb.2022.20.023
中文关键词: 腹动脉球囊置入  宫颈提拉缝合  凶险性前置胎盘  产后大出血
英文关键词: Abdominal aortic balloon occlusion  Cervical hanging maneuver  Dangerous placenta previa  Postpartum hemorrhage
基金项目:陕西省重点研发计划项目(2020SF-050)
作者单位E-mail
折开娥 陕西省人民医院产科 陕西 西安 710068 kaiezhe6@163.com 
张凌燕 陕西省人民医院产科 陕西 西安 710068  
李 虹 陕西省人民医院产科 陕西 西安 710068  
秦 利 陕西省人民医院产科 陕西 西安 710068  
吴桂清 陕西省人民医院产科 陕西 西安 710068  
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中文摘要:
      摘要 目的:探讨腹动脉球囊置入联合宫颈提拉缝合治疗凶险性前置胎盘产后大出血的临床效果。方法:选取我院2019年1月到2021年12月收治的178例凶险性前置胎盘患者作为研究对象,所有患者均采取剖宫产手术,且术后出现产后大出血现象,将所有患者依照术中胎盘位置及植入情况治疗方式分为观察组(n=73)与对照组(n=105)。其中对照组产妇采取腹动脉球囊置入联合宫腔纱条填塞术,观察组采取腹动脉球囊置入联合宫颈提拉缝合治疗,对比两组产妇的剖宫产时间、术后24 h失血量、术中失血量以及总手术时间,相关临床指标,产后泌乳时间和产后1 d、2 d的泌乳量评分以及住院时间,并发症发生情况。结果:两组产妇剖宫产时间、球囊预置术时间对比无明显差异(P>0.05),观察组产妇术后24 h失血量、术中失血量、总手术时间明显低于对照组(P<0.05)。手术前两组产妇凝血酶原时间(PT)、凝血活酶时间(APTT)、血小板(PLT)、纤维蛋白原(FIB)、一氧化氮(NO)、一氧化氮合酶(NOS)、D-二聚体(D-Dimer)无明显差异(P>0.05),治疗后两组产妇PT均升高,观察组高于对照组,PLT、NO、NOS均降低,观察组低于对照组;对照组APTT、FIB无明显变化,但观察组APTT高于对照组,FIB低于对照组;观察组D-Dimer无明显变化,但对照组升高(P<0.05)。观察组产妇的产后1、2 d泌乳量评分明显高于对照组,泌乳时间、术后住院时间明显低于对照组(P<0.05)。观察组产妇术后并发症发生率明显低于对照组(P<0.05)。结论:对凶险性前置胎盘产后大出血患者采取腹动脉球囊置入联合宫颈提拉缝合治疗能够进一步减轻患者术后出血量,且改善患者凝血因子、一氧化氮、一氧化氮合酶、纤维蛋白原、D-二聚体水平,提升泌乳量,减少术后并发症发生率,值得临床应用推广。
英文摘要:
      ABSTRACT Objective: To investigate the clinical effect of abdominal artery balloon implantation combined with cervical pull suture in the treatment of dangerous postpartum hemorrhage of placenta previa. Methods: 178 patients with dangerous placenta previa treated in our hospital from January 2019 to December 2021 were selected as the research object. All patients underwent cesarean section and had postpartum hemorrhage. All patients were divided into observation group (n=73) and control group (n=105) according to the placenta position and implantation conditions during operation. Among them, the control group was treated with abdominal artery balloon implantation combined with Intrauterine gauze packing, and the observation group was treated with abdominal artery balloon implantation combined with cervical lifting suture. The cesarean section time, 24-hour blood loss, intraoperative blood loss and total operation time, relevant clinical indexes, postpartum lactation time, lactation score of 1 and 2 days postpartum, hospital stay and complications were compared between the two groups. Results: There was no significant difference in cesarean section time and total operation time between the two groups (P>0.05). The blood loss 24 hours after operation and intraoperative blood loss in the observation group were significantly lower than those in the control group (P<0.05); There was no significant difference in prothrombin time (PT), thromboplastin time (APTT), platelet (PLT), fibrinogen (FIB), nitric oxide (no), nitric oxide synthase (NOS) and D-Dimer (D-dimer) between the two groups before operation (P>0.05). After treatment, PT in the two groups were increased, PLT, NO, NOS in the observation group were lower than that in the control group. APTT and FIB in the control group did not change significantly, but APTT in the observation group was higher than that in the control group, while FIB was lower than that in the control group. There was no significant change in D-Dimer in the observation group, but it increased in the control group (P<0.05); The scores of lactation volume at 1 and 2 days after delivery in the observation group were significantly higher than those in the control group, and the lactation time and postoperative hospital stay in the observation group were significantly lower than those in the control group (P<0.05); The incidence of postoperative complications in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: abdominal artery balloon implantation combined with cervical pull suture can further reduce the amount of postoperative bleeding, improve the levels of coagulation factor, nitric oxide, nitric oxide synthase, fibrinogen and D-dimer, increase lactation and reduce the incidence of postoperative complications in patients with dangerous postpartum hemorrhage of placenta previa. It is worthy of clinical application and promotion.
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