腹主动脉球囊阻断术在前置胎盘产妇中的应用分析
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摘要
目的探讨前置胎盘产妇剖宫产术中应用腹主动脉球囊阻断术的效果及方法。方法 2015年10月1日至2016年10月31日,在安徽医科大学附属妇幼保健院就诊的前置胎盘产妇22例,采用腹主动脉球囊阻断术后行剖宫产术,对孕妇的手术情况、术中出血量、输血情况、术中和术后并发症以及新生儿预后进行分析。结果 22例孕妇中凶险型前置胎盘20例、中央性前置胎盘并发胎盘植入1例、中央性前置胎盘合并血小板减少1例。腹主动脉球囊充水量7(5~9)m L,术中出血量1 000(600~1 625)m L,12例输注血制品。术中均配合应用各种保守性手术方法止血,6例术后行子宫动脉栓塞术,2例行子宫切除术,1例术后出现休克并发阔韧带血肿,新生儿轻度窒息3例。结论对高危类型的前置胎盘患者在剖宫产术前行腹主动脉球囊预置术,可有效减少术中出血,降低子宫切除的风险;该方法简便易行,便于在基层医院推广。
Objective To explore the effect of abdominal aortic balloon blockage in the preplacental pregnant women. Method Retrospective analysis was conducted on the preplacental situation of 22 cases from Oct. 1 st,2015 to Oct. 31 st,2016. An interventional physician performed right femoral artery puncture and preset the abdominal aortic balloon catheter in the DSA operation room before cesarean. Condition of placenta implantation,blood loss and blood transfusion during the operation,intraoperative and postoperative complications,and Apgar score of neonates were analyzed. Results Among the 22 cases,pernicious placenta previa were 20 cases,complete preplacental were 2 cases. For all cases,ventral aorta balloon water filling 7(5-9) m L,the mean blood loss in the operation was1 000(600-1 625) m L,among which,12 cases received blood transfusion,6 cases received treatment combined with uterine artery embolization and 2 cases received hysterectomy,and 3 neonates with mild asphyxia. Conclusion Abdominal aortic balloon catheter in preplacental patients might effectively reduce the blood loss during cesarean section as well as the risk of hysterectomy through temporary occlusion of the abdominal aorta.
Objective To explore the effect of abdominal aortic balloon blockage in the preplacental pregnant women. Method Retrospective analysis was conducted on the preplacental situation of 22 cases from Oct. 1 st,2015 to Oct. 31 st,2016. An interventional physician performed right femoral artery puncture and preset the abdominal aortic balloon catheter in the DSA operation room before cesarean. Condition of placenta implantation,blood loss and blood transfusion during the operation,intraoperative and postoperative complications,and Apgar score of neonates were analyzed. Results Among the 22 cases,pernicious placenta previa were 20 cases,complete preplacental were 2 cases. For all cases,ventral aorta balloon water filling 7(5-9) m L,the mean blood loss in the operation was1 000(600-1 625) m L,among which,12 cases received blood transfusion,6 cases received treatment combined with uterine artery embolization and 2 cases received hysterectomy,and 3 neonates with mild asphyxia. Conclusion Abdominal aortic balloon catheter in preplacental patients might effectively reduce the blood loss during cesarean section as well as the risk of hysterectomy through temporary occlusion of the abdominal aorta.
引文
[1]彭方亮,罗欣,漆洪波.瘢痕子宫再次妊娠并发前置胎盘197例临床分析.中国实用妇科与产科杂志,2016,32(8):788-791.
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[11]Ann ICRP.The 2007 Recommendations of the international commission on radiological protection[J].ICRP publication,2007,37(2):9-34.
[12]曲度,曲强,张弦,等.腹主动脉阻断术临床原理及其上中下段安全时限探讨-兼述缺血再灌注损伤机制与对策及“二叉树耐受法则”[J].海南医学,2009,20(1):1-13.
[13]刘槃,李世德.暂时性低位腹主动脉阻断术患者血压、心率及血氧饱和度的变化[J].广东医学,2011,32(18):2409-2411.
[14]武钢,肖利民,杨庆永,等.犬体外腹主动脉末端阻断再灌注损伤指标的变化及意义[J].实用医学杂志,2011,27(9):1545-1547.
[15]崔世红,职云晓,张凯,等.腹主动脉球囊阻断术在中央型前置胎盘伴胎盘植入孕妇剖宫产术中的应用[J].中华妇产科杂志,2016,51(9):672-676.
[16]熊娅琴,宋海波,屠重棋,等.彩色多普勒超声引导下腹主动脉内球囊阻断术在骨盆和骶尾部肿瘤手术的应用研究[J].四川大学学报(医学版),2012,43(5):715-719.
[2]谢幸,苟文丽.妇产科学[M].3版.北京:人民卫生出版社,2013:127.
[3]国家卫生和计划委员会.中国卫生和计划生育统计年鉴[M].北京:中国协和医科大学出版社,2015:215.
[4]连岩,王谢桐.胎盘植入的保守性手术治疗[J].实用妇产科杂志,2013,29(8):565-568.
[5]张令浩.盆腔手术中大出血的处理(双侧髂总或腹主动脉钳夹5例报告)[J].人民军医,1976,19(2):56-58.
[6]汤春生,温泽清,尹福波,等.腹主动脉下段暂时阻断术用于控制妇科肿瘤手术中盆腔大出血[J].现代妇产科进展,2003,12(6):445-446.
[7]SCHUURMANS N,KINNON CM,LANE OC,等.产后出血的预防和处理指南[J].现代妇产科进展,2007,16(3):175-185.
[8]DUBOIS J,GAREL L,GRIGNON A,et al.Placenta percreta:balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses[J].Am J Obstet Gynecol,1997,176(3):723-726.
[9]李继军,左常婷,王谢桐,等.腹主动脉球囊阻断术在凶险性前置胎盘并胎盘植入剖宫产术中的应用[J].山东大学学报(医学版),2016,54(9):22-25.
[10]綦小蓉,彭鸿灵.球囊阻断术在胎盘异常附着中的应用[J].实用妇产科杂志,2015,31(12):908-911.
[11]Ann ICRP.The 2007 Recommendations of the international commission on radiological protection[J].ICRP publication,2007,37(2):9-34.
[12]曲度,曲强,张弦,等.腹主动脉阻断术临床原理及其上中下段安全时限探讨-兼述缺血再灌注损伤机制与对策及“二叉树耐受法则”[J].海南医学,2009,20(1):1-13.
[13]刘槃,李世德.暂时性低位腹主动脉阻断术患者血压、心率及血氧饱和度的变化[J].广东医学,2011,32(18):2409-2411.
[14]武钢,肖利民,杨庆永,等.犬体外腹主动脉末端阻断再灌注损伤指标的变化及意义[J].实用医学杂志,2011,27(9):1545-1547.
[15]崔世红,职云晓,张凯,等.腹主动脉球囊阻断术在中央型前置胎盘伴胎盘植入孕妇剖宫产术中的应用[J].中华妇产科杂志,2016,51(9):672-676.
[16]熊娅琴,宋海波,屠重棋,等.彩色多普勒超声引导下腹主动脉内球囊阻断术在骨盆和骶尾部肿瘤手术的应用研究[J].四川大学学报(医学版),2012,43(5):715-719.