普通与凶险型前置胎盘的临床特点及手术疗效比较
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摘要
目的:总结普通与凶险型前置胎盘病人的临床特点,同时比较手术治疗对2种类型前置胎盘的临床疗效。方法:将178例普通与凶险型前置胎盘病人纳入研究范围,其中普通型前置胎盘病人94例(对照组),凶险型前置胎盘病人84例(观察组)。经过详细询问病史和细致检查,总结2组年龄、妊娠时间、胎盘植入情况、附着部位和前置胎盘类型等一般资料。经手术治疗后,比较2组病人手术时间、出血量、弥散性血管内凝血(DIC)、子宫切除及新生儿情况。结果:对照组中前置胎盘发生于前壁者占75.5%,低于观察组的92.9%(P<0.01);2组病人间完全型、部分型和边缘型前置胎盘构成比差异具有统计学意义(P<0.01)。2组病人手术前血红蛋白(Hb)差异无统计学意义(P>0.05),对照组术后Hb高于观察组(P<0.01)。对照组手术时间、出血量、输血量和产后大出血量均低于观察组(P<0.01),术后母亲DIC发生率低于观察组(P<0.05),母亲产后大出血、子宫切除率以及新生儿窒息、气管插管和死亡率方面2组差异均无统计学意义(P>0.05)。结论:前置胎盘对母亲具有较大危害,特别是凶险型前置胎盘术中术后出血量较多,危害更甚。适时的手术治疗能够有效提高前置胎盘病人的生存质量。
Objective:To summarize the clinical characteristics of common and dangerous type placenta previa,and compare the clinical efficacy of the surgical treatment in two types of placenta previa.Methods:Among 178 patients,94 cases with common type placenta previa and 84 cases with dangerous type placenta previa were divided into the control group and observation group,respectively.After the detailed investigating disease history and examination,the age,pregnancy time,placenta implantation,attachment site and placenta previa type in two groups were summarized.After surgical treatment,the operation time,blood loss,diffused intravasular coagulation,hysterectomy and neonatal status between two groups were compared.Results:The incidence rate of the placenta previa attaching anterior wall in control group(75.5%) was lower than that in observation group(92.9%)(P<0.01).The differences of the constituent ratios of complete type,partial type and edge type between two groups were statistically significant(P<0.01).The difference of the level of hemoglobin between two groups before operation was not statistically significant(P>0.05).After operation,the levels of hemoglobin in two groups were lower than that in normal people,the anemia signs in two groups were found,and the level of hemoglobin in control group was higher than that in observation group(P<0.01).The operation time,blood loss,blood transfusion and postpartum hemorrhage in control group were lower than those in observation group(P<0.01),the incidence rate of diffused intravasular coagulation of mother in control group was lower than that in observation group(P<0.05),and the differences of the maternal postpartum haemorrhage,uterine resection rate,neonatal asphyxia rate,endotracheal intubation rate and mortality between two groups were not statistically significant(P>0.05).Conclusions:The placenta previa is great harmful to the mother,and the intraoperative and postoperative bleeding in dangerous type placenta previa are more.Timely surgical treatment can effectively improve the quality of life of patients with placenta previa.
Objective:To summarize the clinical characteristics of common and dangerous type placenta previa,and compare the clinical efficacy of the surgical treatment in two types of placenta previa.Methods:Among 178 patients,94 cases with common type placenta previa and 84 cases with dangerous type placenta previa were divided into the control group and observation group,respectively.After the detailed investigating disease history and examination,the age,pregnancy time,placenta implantation,attachment site and placenta previa type in two groups were summarized.After surgical treatment,the operation time,blood loss,diffused intravasular coagulation,hysterectomy and neonatal status between two groups were compared.Results:The incidence rate of the placenta previa attaching anterior wall in control group(75.5%) was lower than that in observation group(92.9%)(P<0.01).The differences of the constituent ratios of complete type,partial type and edge type between two groups were statistically significant(P<0.01).The difference of the level of hemoglobin between two groups before operation was not statistically significant(P>0.05).After operation,the levels of hemoglobin in two groups were lower than that in normal people,the anemia signs in two groups were found,and the level of hemoglobin in control group was higher than that in observation group(P<0.01).The operation time,blood loss,blood transfusion and postpartum hemorrhage in control group were lower than those in observation group(P<0.01),the incidence rate of diffused intravasular coagulation of mother in control group was lower than that in observation group(P<0.05),and the differences of the maternal postpartum haemorrhage,uterine resection rate,neonatal asphyxia rate,endotracheal intubation rate and mortality between two groups were not statistically significant(P>0.05).Conclusions:The placenta previa is great harmful to the mother,and the intraoperative and postoperative bleeding in dangerous type placenta previa are more.Timely surgical treatment can effectively improve the quality of life of patients with placenta previa.
引文
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[10] OSIFO OD,AGHAHOWA SE.Postoperative wound infection and perioperative prophylactic versus therapeutic antibiotics in paediatric abdominal surgeries:a five-year review[J].West Afr J Med,2012,31(4):247.
[11] BERENSON AB,HIRTH JM,RAHMAN M,et al.Maternal and infant outcomes among women vaccinated against pertussis during pregnancy[J].Hum Vaccin Immunother,2016,12(8):1965.
[12] 左琴,刘淮,黄淑晖,等.输尿管置管对凶险型前置胎盘子宫切除术的效果评价[J].中国妇幼保健,2015,30(24):4110.
[13] 王缨,马秀华.晚期妊娠凶险型前置胎盘75例临床分析[J].中国妇幼保健,2013,28(11):1841.
[2] 李雅岑,叶彩眉,梁琤,等.59例凶险性前置胎盘患者并发症的观察及护理[J].中华护理杂志,2011,46(5):455.
[3] 周洁琼.凶险型前置胎盘40例临床分析[J].重庆医学,2013(5):567.
[4] 曹冬华.凶险型前置胎盘临床特点及治疗分析[J].山东医药,2014,54(18):46.
[5] 刘晓丽,李娜,李敏,等.剖宫产史对前置胎盘妊娠结局的影响[J].中国妇幼保健,2015,30(36):6447.
[6] 吴康,许伟,祖茂衡,等.双侧髂内动脉球囊封堵术在凶险型前置胎盘伴胎盘植入中的应用[J].实用医学杂志,2015,31(20):3361.
[7] 蒋艳敏,刘慧姝,陈昆山.预防性双髂内动脉球囊闭塞术在13例凶险型前置胎盘伴胎盘植入患者中的应用效果[J].中华围产医学杂志,2013,16(8):461.
[8] 杨红兵,舒丹,张利,等.凶险型前置胎盘剖宫产28例临床分析[J].海南医学,2014,25(16):2373.
[9] HOLMA-SUUTARI A,RUOKOJARVI P,LAAKSONEN S,et al.Persistent organic pollutant levels in semi-domesticated reindeer (Rangifer tarandus tarandus L.),feed,lichen,blood,milk,placenta,foetus and calf[J].Sci Total Environ,2014(476/477):125.
[10] OSIFO OD,AGHAHOWA SE.Postoperative wound infection and perioperative prophylactic versus therapeutic antibiotics in paediatric abdominal surgeries:a five-year review[J].West Afr J Med,2012,31(4):247.
[11] BERENSON AB,HIRTH JM,RAHMAN M,et al.Maternal and infant outcomes among women vaccinated against pertussis during pregnancy[J].Hum Vaccin Immunother,2016,12(8):1965.
[12] 左琴,刘淮,黄淑晖,等.输尿管置管对凶险型前置胎盘子宫切除术的效果评价[J].中国妇幼保健,2015,30(24):4110.
[13] 王缨,马秀华.晚期妊娠凶险型前置胎盘75例临床分析[J].中国妇幼保健,2013,28(11):1841.