论文部分内容阅读
目的探索凶险型前置胎盘伴胎盘植入剖宫产术中理想止血方式。方法选取2013年1月-2016年6月该院收治的凶险型前置胎盘伴胎盘植入患者70例,均采用剖宫产术结束妊娠,根据剖宫产术中采取的止血方式分为观察组(37例)与对照组(33例)。观察组止血方式为子宫外压迫止血法,对照组止血方式为子宫内压迫止血法,对比分析两组患者的手术时间、术中出血量、子宫切除率及产后出血率。结果观察组手术时间为(108±17)min,显著低于对照组(156±26)min;观察组术中出血量为(925±218)min,显著低于对照组(1 837±382)min;观察组术后住院时间为(7.25±1.92)d,显著低于对照组(9.11±2.07)d,两组比较差异均有统计学意义(t=9.236 0,P=0.000 0;t=12.434 6,P=0.000 0;t=3.899 7,P=0.000 2)。观察组子宫切除率(5.41%)、产后出血率(10.81%)、弥散性血管内凝血(DIC)发生率(21.62%)、重症监护室(ICU)转入率(40.54%)显著低于对照组(39.39%、48.48%、45.45%及81.82%),两组比较差异均有统计学意义(χ~2=11.968 1,P=0.000 0;χ~2=12.131 0,P=0.000 0;χ~2=4.491 0,P=0.036 2;χ~2=12.383 3,P=0.000 0);两组患者产褥感染率分别为2.70%和6.06%,差异无统计学意义(χ~2=0.010 3,P=0.924 3)。结论凶险型前置胎盘伴胎盘植入剖宫产术中应用子宫外压迫止血法疗效确切,具有手术时间及术后住院时间短,术中出血量少,子宫切除率、产后出血率、DIC发生率、ICU转入率低等优点。
Objective To explore the dangerous type of placenta previa placenta accreta with cesarean section in the ideal way to stop bleeding. Methods From January 2013 to June 2016, 70 cases of dangerous placenta accreta placenta accreta were admitted to this hospital. Cesarean section was used to terminate the pregnancy. According to the method of hemostasis adopted in cesarean section, (37 cases) and control group (33 cases). The way of hemostasis in the observation group was the hemostasis method of uterine compression. The method of hemostasis in the control group was intrauterine compression hemostasis method. The operation time, intraoperative blood loss, hysterectomy rate and postpartum hemorrhage rate were compared between the two groups. Results The operative time in the observation group was (108 ± 17) min, which was significantly lower than that in the control group (156 ± 26) min. The bleeding volume in the observation group was (925 ± 218) min, significantly lower than that in the control group (1837 ± 382) min. The postoperative hospital stay in the observation group was (7.25 ± 1.92) d, which was significantly lower than that in the control group (9.11 ± 2.07) d. There was significant difference between the two groups (t = 9.236 0, P = 0.000 0; 12.434 6, P = 0.000 0; t = 3.899 7, P = 0.000 2). The rate of hysterectomy (5.41%), postpartum hemorrhage rate (10.81%), diffuse intravascular coagulation (DIC) rate (21.62%) and intensive care unit (40.54%) in observation group were significantly lower than those in control group (Χ ~ 2 = 11.968 1, P = 0.000 0; χ ~ 2 = 12.131 0, P = 0.000 0; χ 2 = 4.491 0, P = 0.036 2; χ ~ 2 = 12.383 3, P = 0.000 0). The rates of puerperal infection in two groups were 2.70% and 6.06% respectively, with no significant difference (χ ~ 2 = 0.010 3, P = 0.924 3). Conclusions The use of extrauterine compression to stop bleeding in cesarean section with placenta previa placenta accreta has a definite curative effect. It has the advantages of shorter operation time, shorter postoperative hospital stay, less intraoperative blood loss, hysterectomy, postpartum hemorrhage, and DIC Rate, ICU transfer rate is low and so on.