超声导引下腹主动脉球囊预置新方法预防产后出血
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摘要
目的探讨超声导引下腹主动脉球囊预置新方法在预防前置胎盘剖宫产术后出血的临床价值。方法 16例孕产妇经彩色超声、MR诊断为凶险性前置胎盘或中央型前置胎盘伴胎盘植入,剖宫产前通过超声导引预置下腹主动脉球囊,术中间歇阻断腹主动脉。记录术中出血量、输血量及子宫缝合时间。结果 16例均成功接受超声导引下预置球囊阻断腹主动脉,剖宫产术中平均出血量(756±222) m L,输血量(440±219) m L,子宫缝合时间(28.4±7.9) min。胎儿娩出后DSA下检查球囊置放位置准确,无明显移位。结论超声导引下腹主动脉球囊阻断术操作简单、安全,在前置胎盘伴胎盘植入产妇剖宫产术中控制出血效果显著,避免了X射线和对比剂对胎儿的不良影响。
Objective To discuss the clinical value of a new method of ultrasound-guided preimplantation of abdominal aorta balloon in prevention of postpartum hemorrhage after cesarean section due to placenta previa. Methods A total of 16 delivery women with dangerous placenta previa or central placenta previa complicated by placenta implantation, which were confirmed by color ultrasound and MR, were enrolled in this study. Ultrasound-guided pre-implantation of abdominal aorta balloon was performed before cesarean section was carried out, intermittent occlusion of abdominal aorta was employed during the procedure. The amount of intraoperative blood loss, the volume of blood transfusion, and the time spent for uterine suture were recorded. Results Successful ultrasound-guided pre-implantation of abdominal aorta balloon was accomplished in all 16 delivery women. During the procedure of cesarean section, the amount of blood loss was(756±222) m L, the volume of blood transfusion was(440±219) m L, and the time spent for uterine suture was(28.4 ±7.9) min. DSA examination performed after fetus was delivery showed that the location of the balloon placement was accurate with no obvious displacement. Conclusion The ultrasound-guided abdominal aortic balloon occlusion technique is simple and safe. It has significant bleeding-control effect in the performance of cesarean section in delivery women with placenta previa complicated by placenta implantation, and the adverse effects of X-rays and contrast agents on the fetus can be avoided.
Objective To discuss the clinical value of a new method of ultrasound-guided preimplantation of abdominal aorta balloon in prevention of postpartum hemorrhage after cesarean section due to placenta previa. Methods A total of 16 delivery women with dangerous placenta previa or central placenta previa complicated by placenta implantation, which were confirmed by color ultrasound and MR, were enrolled in this study. Ultrasound-guided pre-implantation of abdominal aorta balloon was performed before cesarean section was carried out, intermittent occlusion of abdominal aorta was employed during the procedure. The amount of intraoperative blood loss, the volume of blood transfusion, and the time spent for uterine suture were recorded. Results Successful ultrasound-guided pre-implantation of abdominal aorta balloon was accomplished in all 16 delivery women. During the procedure of cesarean section, the amount of blood loss was(756±222) m L, the volume of blood transfusion was(440±219) m L, and the time spent for uterine suture was(28.4 ±7.9) min. DSA examination performed after fetus was delivery showed that the location of the balloon placement was accurate with no obvious displacement. Conclusion The ultrasound-guided abdominal aortic balloon occlusion technique is simple and safe. It has significant bleeding-control effect in the performance of cesarean section in delivery women with placenta previa complicated by placenta implantation, and the adverse effects of X-rays and contrast agents on the fetus can be avoided.
引文
[1]Lau TK,Leung TY.Prenatal diagnosis of morbidly adherent placenta[J].Int J Obstet Anesth,2011,20:107-109.
[2]李晓燕,王晓黎,李蕾,等.低位腹主动脉球囊阻断在凶险型前置胎盘中的应用价值[J].国际妇产科学杂志,2016,43:291-294.
[3]宋鹏,吴宁.球囊临时阻断技术在凶险性前置胎盘剖宫产术中的应用[J].介入放射学杂志,2017,26:451-454.
[4]韦小芳.球囊暂时阻断腹主动脉下段预防及控制完全性前置胎盘产后出血的临床研究[D].广西医科大学,2016.
[5]王洪雨,孙成建,王彦华,等.腹主动脉预置球囊辅助前置胎盘伴胎盘植入剖宫产临床应用[J].介入放射学杂志,2017,26:922-926.
[6]严小丽,陈诚,常青,等.凶险性前置胎盘20例临床分析[J].实用妇产科杂志,2013,29:704-707.
[7]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,2016,51:672-676.
[8]陈坤前,李发旺,朱恩全,等.超声导引球囊阻断术在13例凶险陛前置胎盘剖宫产中的应用[J].介入放射学杂志,2017,26:915-917.
[9]Becker F,Van Poppel H,Hakenberg OW,et al.Assessing the impact of ischaemia time during partial nephrectomy[J].Eur Urol,2009,56:625-634.
[10]刘傲飞.腹主动脉及其主要分支的CT测量[D].第二军医大学,2011.
[2]李晓燕,王晓黎,李蕾,等.低位腹主动脉球囊阻断在凶险型前置胎盘中的应用价值[J].国际妇产科学杂志,2016,43:291-294.
[3]宋鹏,吴宁.球囊临时阻断技术在凶险性前置胎盘剖宫产术中的应用[J].介入放射学杂志,2017,26:451-454.
[4]韦小芳.球囊暂时阻断腹主动脉下段预防及控制完全性前置胎盘产后出血的临床研究[D].广西医科大学,2016.
[5]王洪雨,孙成建,王彦华,等.腹主动脉预置球囊辅助前置胎盘伴胎盘植入剖宫产临床应用[J].介入放射学杂志,2017,26:922-926.
[6]严小丽,陈诚,常青,等.凶险性前置胎盘20例临床分析[J].实用妇产科杂志,2013,29:704-707.
[7]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,2016,51:672-676.
[8]陈坤前,李发旺,朱恩全,等.超声导引球囊阻断术在13例凶险陛前置胎盘剖宫产中的应用[J].介入放射学杂志,2017,26:915-917.
[9]Becker F,Van Poppel H,Hakenberg OW,et al.Assessing the impact of ischaemia time during partial nephrectomy[J].Eur Urol,2009,56:625-634.
[10]刘傲飞.腹主动脉及其主要分支的CT测量[D].第二军医大学,2011.