摘要
目的探讨腹主动脉球囊阻断术对凶险性前置胎盘伴胎盘植入患者术中出血量、子宫切除率及肾功能的影响。方法回顾性分析住院分娩的凶险性前置胎盘合并胎盘植入的患者148例，根据是否接受腹主动脉球囊阻断术分为两组：研究组75例，术前安置腹主动脉球囊、术中临时阻断腹主动脉血流；对照组73例，不安置腹主动脉球囊。比较两组患者一般情况、出血量、输血量、子宫切除率、手术时间、尿酸、肌酐及尿素水平。结果研究组术中平均出血量、输血量以及子宫切除率均低于对照组（P〈0．05）；两组患者新生儿1min、5min Apgar评分差异无统计学意义（P〉0．05）；组内比较，两组术后各时点尿酸、肌酐及尿素水平较术前均有不同程度的升高，其中术后48h肌酐水平与术前比较，差异有统计学意义（P〈0．05）；组间比较，除研究组术后48h尿酸水平较对照组低（P〈0．05），其余时段3项指标两组差异无统计学意义（P〉0．05）。纳入研究的患者未出现明显肾功能衰竭，尿素、肌酐以及尿酸水平的升高均在正常范围内。结论植入型凶险性前置胎盘患者术前安置腹主动脉球囊，术中临时阻断腹主动脉血流可减少术中出血量及输血量、降低子宫切除率，不会造成严重肾功能损害，有利于存在大出血高风险产妇剖宫产术中的麻醉管理。
Objective To investigate the effects of intra-aortic balloon occlusion on the volume of blood loss, the rate of hysterectomy and the renal function in pernicious placenta previa with placenta accreta. Methods A retrospective study from January 2014 and June 2017 consists of 148 inpatients diagnosed of pernicious placenta previa with placenta accreta. The patients received cesarean section followed prophylactic abdominal aortic balloon occlusion were divided into study group （75 cases） and the patients having no intra-aortic abdominal aortic balloon implantation device implanted were divided into control group （73 cases）. The following clinical parameters were compared in two groups： the general condition of the patient, estimated blood loss, transfused blood products, the rate of hysterectomy, operating time, uric acid, serum creatinine and urea. Results The mean estimated blood loss, blood transfusion volumes and the rates of hysterectomy in study group were statistically significant lower than those parameters in the control group （P〈0.05）. No statistical difference was observed in Apgar scores of newborn babies after 1, 5 min between two groups （P〉0.05）. Intragroup comparision： there was statistically significant higher elevation in the post-operative levels of uric acid, creatinine and urea than the elevation seen pre-operatively （P〈0.05）. Comparision between groups： except the 48 h post-operative uric levels of study group were lower than uric levels of the control group （P〈0.05）, there was no significant different of the three indices between two groups （P〈0.05）. Moreover, the study group did not show any significant renal function impairment. The values of uric acid, creatinine and urea level were within the normal range. Conclusions In patients having pernicious placenta previa with placenta accreta, preoperative intra-aortic balloon implant and temporary occlusion of the abdominal aorta during the operation can significantly reduce the blood loss, blood transfusion, rates of hysterectomy without causing significant renal function impairment. Intra-operative abdominal aortic occlusion can help to maintain anesthesia management on the parturients with high risk of bleeding in cesarean section.
作者
袁唯佳
何开华
Yuan Weijia;He Kaihua(Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China)
出处
《国际麻醉学与复苏杂志》
CAS
2018年第4期303-307,共5页
International Journal of Anesthesiology and Resuscitation
基金
国家临床重点专科建设项目（财社[2011]170号）
重庆市卫生局医学重点学科建设项目（渝卫科教[2007]2号）
关键词
前置胎盘
植入性胎盘
腹主动脉球囊阻断术
失血
手术
子宫切除术
肾功能
Placenta previa
Placenta increta
Abdominal aortic balloon occlusion
Blood loss, surgical
Hyterectomy
Renal function
