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目的观察和分析不同胎盘处理方法对部分性前置胎盘患者剖宫产术中出血及血清β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)水平的影响。方法选择2009年6月—2013年6月收治的100例部分性前置胎盘产妇作为研究对象,根据术中胎盘处理方法分为对照组39例和观察组61例。对照组以传统方法处理胎盘;观察组处理胎盘方法为应用长弯血管钳对胎盘基底部进行钳夹,而后于其上缘处进行胎盘剥离,对剩余胎盘组织进行逐一“8”字缝合。对比两组产妇的手术时间、术中出血量、产后24 h出血量及术后1、3、7 d的血清β-HCG水平。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果观察组产妇的手术时间、术中出血量、产后24 h出血量[(38.3±7.6)min、(391.8±31.2)、(342.2±32.6)ml]均显著低于对照组[(59.2±9.7)min、(653.3±32.8)、(528.8±36.4)ml],差异均有统计学意义(均P<0.05)。观察组产妇术后1、7 d的血清β-HCG水平[(29 570±1 374)、(285±31)U/L]显著高于对照组[(14 365±1 089)、(211±30)U/L],差异均有统计学意义(均P<0.05)。结论在部分性前置胎盘产妇的剖宫产术中,应用血管钳对胎盘基底部进行钳夹,而后于其上缘剥离胎盘并逐一“8”字缝合剩余胎盘组织的处理胎盘方法,可有效减少术中和术后的出血量,缩短手术时间,效果满意,值得临床推广,但在术后需要对患者的血清β-HCG水平进行监测。
Objective To observe and analyze the effects of different placenta treatments on hemorrhage and β-human chorionic gonadotropin (β-HCG) levels in cesarean section in partial placenta previa. Methods 100 cases of partial placenta previa from June 2009 to June 2013 were selected as study subjects. According to intraoperative placenta treatment, 39 cases were divided into control group and observation group (61 cases). In the control group, the placenta was treated by the conventional method. In the observation group, the placenta was treated by long-clamp vascular forceps to clamp the base of the placenta and then the placenta was peeled off at the upper edge of the placenta. The remaining placenta tissues were sutured one by one . The operation time, intraoperative blood loss, blood loss at 24 h postpartum and serum β-HCG levels at 1, 3 and 7 days after operation were compared between the two groups. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The operation time, intraoperative blood loss, blood loss at 24 hours postpartum (38.3 ± 7.6) min, (391.8 ± 31.2) and (342.2 ± 32.6) ml in observation group were significantly lower than those in control group [(59.2 ± 9.7) ) min, (653.3 ± 32.8) and (528.8 ± 36.4) ml, respectively, with statistical significance (all P <0.05). The level of serum β-HCG in the observation group at 1, 7 days after operation was significantly higher than that in the control group [(29 570 ± 1 374), (285 ± 31) U / L] [(14 365 ± 1 089), (211 ± 30) U / L], the difference was statistically significant (all P <0.05). Conclusion In the partial cesarean section of placenta previa, the forceps were used to clamp the base of the placenta, and then the placenta was peeled off by the upper edge of the placenta and the placenta was stitched one by one. Can effectively reduce intraoperative and postoperative bleeding, shorten the operation time, the effect is satisfactory, worthy of clinical promotion, but after the patient’s serum β-HCG levels need to be monitored.