宫腔填塞联合水囊压迫止血治疗凶险性前置胎盘的临床观察及安全性分析
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摘要
目的探讨宫腔填塞联合水囊压迫止血治疗凶险性前置胎盘的临床效果以及安全性。方法选取2015年1月—2016年6月信阳市中医院收治的凶险性前置胎盘产妇40例,随机将其分为对照组和观察组,各20例。对照组采用8字缝合和子宫动脉结扎方法治疗,观察组给予子宫填塞联合水囊压迫治疗。记录两组术后24、48 h出血量以及取出纱布后阴道流血量,观察两组术后再出血发生率、弥散性血管内凝血发生率及子宫切除率。并记录术后并发症发生情况。结果观察组术后24 h出血量、48 h出血量以及阴道流血量均少于对照组(P<0.05)。观察组再出血发生率、弥散性血管内凝血发生率及子宫切除率均低于对照组(P<0.05)。观察组并发症发生率为5%(1/20),高于对照组的20%(4/20)(P<0.05)。观察组术后收缩压、舒张压、心率均高于对照组(P<0.05)。结论宫腔填塞联合水囊压迫止血治疗凶险性前置胎盘的临床效果显著,并且并发症发生率较低,具有一定的安全性,值得临床推荐应用。
Objective To investigate the clinical effect and safety of uterine cavity packing combined with water sac compression hemostasis in the treatment of dangerous placenta previa. Methods 40 cases of dangerous placenta previa admitted to TCM Hospital of Xinyang from January 2015 to June 2016 were selected as the subjects of this study. Patients were randomly divided into observation group and control group. Patients in control group were treated with 8-word suture and uterine artery ligation. Patients in the observation group were treated with uterine tamponade combined with water balloon compression.The after 24 hours hemorrhage, 48 hours bleeding, vaginal bleeding volume after removal of gauze, postoperative rebleeding rate, disseminated intravascular coagulation rate and hysterectomy rate were observed. The incidence of complication was recorded. Results The after 24 hours hemorrhage, 48 hours bleeding and the removal of water sac of observation group were lower than those of control group(P<0.05). The postoperative rebleeding rate, disseminated intravascular coagulation rate and hysterectomy rate of observation group were lower than those of control group(P<0.05). The incidence of observation groups[5%(1/20)] was lower than that of control group[20%(4/20)](P<0.05). The SBP, DBP and HR of observation group were lower than those of control group(P<0.05). Conclusion The clinical effect of intrauterine tamponade combined with water sac compression hemostasis in the treatment of perilous placenta previa is significant, and the incidence of adverse reaction is low. It is safe and worthy of clinical application.
Objective To investigate the clinical effect and safety of uterine cavity packing combined with water sac compression hemostasis in the treatment of dangerous placenta previa. Methods 40 cases of dangerous placenta previa admitted to TCM Hospital of Xinyang from January 2015 to June 2016 were selected as the subjects of this study. Patients were randomly divided into observation group and control group. Patients in control group were treated with 8-word suture and uterine artery ligation. Patients in the observation group were treated with uterine tamponade combined with water balloon compression.The after 24 hours hemorrhage, 48 hours bleeding, vaginal bleeding volume after removal of gauze, postoperative rebleeding rate, disseminated intravascular coagulation rate and hysterectomy rate were observed. The incidence of complication was recorded. Results The after 24 hours hemorrhage, 48 hours bleeding and the removal of water sac of observation group were lower than those of control group(P<0.05). The postoperative rebleeding rate, disseminated intravascular coagulation rate and hysterectomy rate of observation group were lower than those of control group(P<0.05). The incidence of observation groups[5%(1/20)] was lower than that of control group[20%(4/20)](P<0.05). The SBP, DBP and HR of observation group were lower than those of control group(P<0.05). Conclusion The clinical effect of intrauterine tamponade combined with water sac compression hemostasis in the treatment of perilous placenta previa is significant, and the incidence of adverse reaction is low. It is safe and worthy of clinical application.
引文
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[6]程军军,祝巧阳.两种不同手术方法在植入型凶险性前置胎盘治疗中的临床疗效比较研究[J].浙江创伤外科,2018,23(2):335-337.
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[9]王晓华,李春梅,谢晓君,等.术前预置髂内动脉球囊联合子宫下段环形缝扎在凶险性前置胎盘致产后出血中的应用[J].昆明医科大学学报,2018,39(1):73-76.
[10]吴玲.凶险性前置胎盘并发产后大出血患者行围生期急症子宫切除术的最佳手术时机及疗效观察[J].实用妇科内分泌杂志(电子版),2017,4(33):112-113.
[11]罗秀珍.用宫腔阴道填塞法联合欣母沛对因患有凶险型前置胎盘所致产后出血的产妇进行治疗的效果[J].当代医药论丛,2017,15(20):51-52.
[12]梅又文,罗丹.预置髂内动脉球囊联合子宫动脉栓塞治疗凶险性前置胎盘的病例对照研究[J].现代妇产科进展,2017,26(10):770-772.
[13]龚正,成小丽,迟源,等.凶险性前置胎盘合并胎盘植入剖宫产术中腹主动脉远端球囊阻断的临床疗效[J].中国介入影像与治疗学,2017,14(6):351-354.
[14]段旭华,王艳丽,韩新巍,等.间歇性阻断腹主动脉联合剖宫产术与常规剖腹产术治疗凶险性前置胎盘并胎盘植入的对照研究[J].临床放射学杂志,2016,35(11):1746-1750.
[15]于万芹,谭书卓,陈红月,等.海扶刀治疗妊娠期植入型凶险性前置胎盘对患者术中情况、妊娠结局及HCG值的影响[J].河北医药,2016,38(8):1222-1225.
[2]杨艳.子宫前壁切除及修补术治疗凶险性前置胎盘并胎盘植入42例[J].首都食品与医药,2018,25(13):24-25.
[3]陈建虹,宋文侠.子宫胎盘剥离面缝扎术联合双侧子宫动脉结扎术治疗对凶险性前置胎盘患者的预后指标及子宫切除率的影响[J].中国妇幼保健,2018,33(12):2840-2843.
[4]蔡晓立.双侧髂内动脉置管联合剖宫产术治疗对凶险性前置胎盘合并胎盘植入患者围术期指标、子宫切除率及母婴结局的影响[J].中国妇幼保健,2018,33(12):2843-2845.
[5]李晓琴,杨朝霞,马萍,等.止血带捆绑下子宫修复成形术治疗凶险性前置胎盘合并穿透性胎盘植入疗效分析[J].中国实用妇科与产科杂志,2018,34(6):684-687.
[6]程军军,祝巧阳.两种不同手术方法在植入型凶险性前置胎盘治疗中的临床疗效比较研究[J].浙江创伤外科,2018,23(2):335-337.
[7]王文.凶险性前置胎盘的危险因素及产前胎盘植入的诊断[D].广州:南方医科大学,2016.
[8]宁嫦.凶险性前置胎盘并胎盘植入实施子宫前壁切除及修补术的临床研究[J].实用妇科内分泌杂志(电子版),2018,5(3):17-18,20.
[9]王晓华,李春梅,谢晓君,等.术前预置髂内动脉球囊联合子宫下段环形缝扎在凶险性前置胎盘致产后出血中的应用[J].昆明医科大学学报,2018,39(1):73-76.
[10]吴玲.凶险性前置胎盘并发产后大出血患者行围生期急症子宫切除术的最佳手术时机及疗效观察[J].实用妇科内分泌杂志(电子版),2017,4(33):112-113.
[11]罗秀珍.用宫腔阴道填塞法联合欣母沛对因患有凶险型前置胎盘所致产后出血的产妇进行治疗的效果[J].当代医药论丛,2017,15(20):51-52.
[12]梅又文,罗丹.预置髂内动脉球囊联合子宫动脉栓塞治疗凶险性前置胎盘的病例对照研究[J].现代妇产科进展,2017,26(10):770-772.
[13]龚正,成小丽,迟源,等.凶险性前置胎盘合并胎盘植入剖宫产术中腹主动脉远端球囊阻断的临床疗效[J].中国介入影像与治疗学,2017,14(6):351-354.
[14]段旭华,王艳丽,韩新巍,等.间歇性阻断腹主动脉联合剖宫产术与常规剖腹产术治疗凶险性前置胎盘并胎盘植入的对照研究[J].临床放射学杂志,2016,35(11):1746-1750.
[15]于万芹,谭书卓,陈红月,等.海扶刀治疗妊娠期植入型凶险性前置胎盘对患者术中情况、妊娠结局及HCG值的影响[J].河北医药,2016,38(8):1222-1225.