宫腔球囊压迫对前置胎盘的止血效果及对氧化应激反应的影响
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摘要
目的探讨产科前置胎盘宫腔球囊压迫止血的效果及对氧化应激反应的影响。方法选取2016年1月-2017年12月在我院接受治疗的前置胎盘患者60例,根据最终选取的治疗方案分为观察组(n=32)和对照组(n=28),观察组患者给予宫腔球囊压迫止血,对照组患者给予宫腔纱布填塞止血,观察两组患者手术时间、术中出血量等,同时检测去甲肾上腺素(NE)、丙二醛(MDA)、内皮素-1(ET-1)以及活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)水平。结果观察组患者手术时间、术中出血量、术后出血量和输血率分别为(60.04±4.53)min、(340.03±50.10)ml、(78.89±30.02)ml和21.88%,明显低于对照组(P<0.05);观察组术后24 h发热比例为18.75%,明显低于对照组(P<0.05);观察组术后NE、MDA和ET-1分别为(170.04±54.49)ng/ml、(190.02±46.59)nmol/ml和(120.04±24.45)pg/ml,明显低于对照组(P<0.05);观察组术后APTT、TT和PT分别为(33.01±2.03)s、(13.30±2.01)s和(13.10±1.78)s,明显低于对照组(P<0.05)。结论前置胎盘宫腔球囊压迫止血有较好的效果,产妇应激反应轻,值得临床使用。
Objective To investigate the effect of uterine cavity balloon compression on obstetric placenta previa. Methods Sixty patients with placenta previa treated in our hospital between January 2016 and December 2017 were selected and divided into the observation group( n = 32) and the control group( n = 28) according to the final treatment plans. The patients in the observation group were given intrauterine balloon compression to stop bleeding while those in the control group were given uterine gauze packing to stop bleeding. The duration of surgery and the amount of intraoperative bleeding were observed in the two groups. The levels of norepinephrine( NE),malondialdehyde( MDA),endothelin-1( ET-1),activated partial thromboplastin time( APTT),prothrombin time( PT) and thrombin time( TT) were also detected. Results The duration of surgery intraoperative bleeding,postoperative bleeding volume and blood transfusion rate in the observation group were( 60. 04±4. 53) min,( 340. 03±50. 10) ml,( 78. 89±30. 02) ml and 21. 88%,respectively,which were significantly shorter or lower than those in the control group( P<0. 05). The percentage of postoperative 24 h fever in the observation group was 18. 75%,which was significantly lower than that in the control group( P<0. 05). The postoperative levels of NE,MDA and ET-1 of the observation group were( 170. 04 ± 54. 49) ng/ml,( 190. 02±46. 59) nmol/ml and( 120. 04±24. 45) pg/ml,respectively,which were significantly lower than those of the control group( P<0. 05). The APTT,TT and PT in the observation group were( 33. 01±2. 03) s,( 13. 30±2. 01) s and( 13. 10±1. 78) s,respectively,which were significantly shorter than those in the control group( P<0. 05). Conclusion Placenta previa uterine balloon compression hemostasis has a good effect and maternal stress reactions are mild,so it is worthy of clinical use.
Objective To investigate the effect of uterine cavity balloon compression on obstetric placenta previa. Methods Sixty patients with placenta previa treated in our hospital between January 2016 and December 2017 were selected and divided into the observation group( n = 32) and the control group( n = 28) according to the final treatment plans. The patients in the observation group were given intrauterine balloon compression to stop bleeding while those in the control group were given uterine gauze packing to stop bleeding. The duration of surgery and the amount of intraoperative bleeding were observed in the two groups. The levels of norepinephrine( NE),malondialdehyde( MDA),endothelin-1( ET-1),activated partial thromboplastin time( APTT),prothrombin time( PT) and thrombin time( TT) were also detected. Results The duration of surgery intraoperative bleeding,postoperative bleeding volume and blood transfusion rate in the observation group were( 60. 04±4. 53) min,( 340. 03±50. 10) ml,( 78. 89±30. 02) ml and 21. 88%,respectively,which were significantly shorter or lower than those in the control group( P<0. 05). The percentage of postoperative 24 h fever in the observation group was 18. 75%,which was significantly lower than that in the control group( P<0. 05). The postoperative levels of NE,MDA and ET-1 of the observation group were( 170. 04 ± 54. 49) ng/ml,( 190. 02±46. 59) nmol/ml and( 120. 04±24. 45) pg/ml,respectively,which were significantly lower than those of the control group( P<0. 05). The APTT,TT and PT in the observation group were( 33. 01±2. 03) s,( 13. 30±2. 01) s and( 13. 10±1. 78) s,respectively,which were significantly shorter than those in the control group( P<0. 05). Conclusion Placenta previa uterine balloon compression hemostasis has a good effect and maternal stress reactions are mild,so it is worthy of clinical use.
引文
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[4]吴寒冰,艾玲,钟少平,等.宫腔球囊联合欣母沛在前置胎盘剖宫产术中止血的临床观察[J].中华全科医学,2015,13(2):238.
[5]王跃芬.球囊压迫联合子宫动脉横行捆绑术与宫腔填纱术在前置胎盘中应用效果的比较[J].中国临床医生杂志,2015,43(9):72.
[6]王利民,夏艳梅,周辉,等.Bakri球囊在介入治疗凶险型前置胎盘中的应用[J].现代临床医学,2016,42(6):420.
[7]UYGUR D,ALTUN ENSARI T,OZGU-ERDINC A S,etal.Successful use of BT-Cathballoon tamponade in the management of postpartum haemorrhage due to placenta previa[J].Eur J Obstet Gynecol Reprod Biol,2014,181(6):223.
[8]林秀美.宫腔球囊填塞与宫腔塞纱治疗前置胎盘剖宫产产后出血的效果对比分析[J].中国现代药物应用,2017,11(18):48.
[9]刘恒.止血带加宫腔内纱布条填塞在前置胎盘剖宫产术中的应用[J].中国实用医药,2014,9(17):89.
[10]BECKMANN M M,CHAPLIN J.Bakri balloon during cesarean delivery for placenta previa[J].Int J Gynecol Obst,2014,124(2):118.
[11]BROEKMAN E A,VERSTEEG H,VOS L D,etal.Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa[J].Int J Gynecol Obstet,2015,128(2):118.
[12]李艳,陈春梅,罗丹,等.介入术联合宫腔球囊在减少凶险性前置胎盘剖宫产术中出血的应用[J].四川医学,2015,36(10):1426.
[13]代秀云,刘国杰,郭兆君.两种方法在治疗前置胎盘导致的产后出血中临床效果观察[J].中国实用医药,2014,9(2):141.
[14]高洁,张芳真.Bakri球囊填塞与B-Lynch缝合加宫腔填纱术治疗中央性前置胎盘产后出血的分析[J].赣南医学院学报,2014,34(3):378.
[15]孟茜,陈海霞,莫应萍,等.宫腔球囊填塞在治疗前置胎盘产妇剖宫产术后出血中的应用[J].中国妇幼保健,2015,30(6):957.
[2]MAHER M A,ABDELAZIZ A.Comparison between two management protocols for postpartum hemorrhage during cesarean section in placenta previa:Balloon protocol versus non-balloon protocol[J].J Obstet Gynaecol Res,2017,43(3):447.
[3]KONDOH E,KAWASAKI K,KAWAMURA A,etal.Successful management of intraoperative hemorrhage from placenta previa accreta:intrauterine tamponade balloons brought out through the abdominal wall[J].J MaternFetal Neo Med,2013,27(3):309.
[4]吴寒冰,艾玲,钟少平,等.宫腔球囊联合欣母沛在前置胎盘剖宫产术中止血的临床观察[J].中华全科医学,2015,13(2):238.
[5]王跃芬.球囊压迫联合子宫动脉横行捆绑术与宫腔填纱术在前置胎盘中应用效果的比较[J].中国临床医生杂志,2015,43(9):72.
[6]王利民,夏艳梅,周辉,等.Bakri球囊在介入治疗凶险型前置胎盘中的应用[J].现代临床医学,2016,42(6):420.
[7]UYGUR D,ALTUN ENSARI T,OZGU-ERDINC A S,etal.Successful use of BT-Cathballoon tamponade in the management of postpartum haemorrhage due to placenta previa[J].Eur J Obstet Gynecol Reprod Biol,2014,181(6):223.
[8]林秀美.宫腔球囊填塞与宫腔塞纱治疗前置胎盘剖宫产产后出血的效果对比分析[J].中国现代药物应用,2017,11(18):48.
[9]刘恒.止血带加宫腔内纱布条填塞在前置胎盘剖宫产术中的应用[J].中国实用医药,2014,9(17):89.
[10]BECKMANN M M,CHAPLIN J.Bakri balloon during cesarean delivery for placenta previa[J].Int J Gynecol Obst,2014,124(2):118.
[11]BROEKMAN E A,VERSTEEG H,VOS L D,etal.Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa[J].Int J Gynecol Obstet,2015,128(2):118.
[12]李艳,陈春梅,罗丹,等.介入术联合宫腔球囊在减少凶险性前置胎盘剖宫产术中出血的应用[J].四川医学,2015,36(10):1426.
[13]代秀云,刘国杰,郭兆君.两种方法在治疗前置胎盘导致的产后出血中临床效果观察[J].中国实用医药,2014,9(2):141.
[14]高洁,张芳真.Bakri球囊填塞与B-Lynch缝合加宫腔填纱术治疗中央性前置胎盘产后出血的分析[J].赣南医学院学报,2014,34(3):378.
[15]孟茜,陈海霞,莫应萍,等.宫腔球囊填塞在治疗前置胎盘产妇剖宫产术后出血中的应用[J].中国妇幼保健,2015,30(6):957.