国际麻醉学与复苏杂志   2018, Issue (4): 0-0
    
腹主动脉球囊置入对植入型凶险性前置胎盘患者出血及肾功能的影响
袁唯佳, 何开华1()
1.重庆医科大学附属第一医院麻醉科
Effect of Intra-aortic abdominal aortic balloon implantation on bleeding and renal function in patients having pernicious placenta previa with placenta accreta
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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2014年1月~2017年6月住院分娩的凶险性前置胎盘合并胎盘植入病例148例,术前安置腹主动脉球囊术中临时阻断腹主动脉血流患者列为研究组(n=75),未安置球囊者列为对照组(n=73),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均<0.05);两组患者新生儿出生后1min、5min的Apgar评分差异无统计学差异(p均>0.05);组内比较:两组术后尿酸、肌酐及尿素均较术前有不同程度的升高,其中两组术后48h肌酐水平均较术前升高有统计学意义(p均<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),余时段两组的三项指标比较无明显差异。且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;术中腹主动脉球阻断可安全用于植入型凶险性前置胎盘剖宫产患者。

关键词: 凶险性前置胎盘;腹主动脉球囊;出血量;子宫切除率;肾功能
Abstract:

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 accret.Methods:A retrospective study from January 2014 and June 2017 consisting of 148 inpatients diagnosed of pernicious placenta lrevia with placenta accreta.The patients receiving cesarean section followed p[]rophylactic abdominal aortic balloon occlusion were divided into study group(n=75) and the patients having no IABP device implanted were divided into control group(n=73).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 during,uric acid, serum creatinine and urea.Result:The mean estimated blood loss,blood transfusion volume and the rate of hysterectomy in study group were lower than those in the control group,with a statistically significant difference(p<0.05);No statistical difference was observed in Apgar Scores of postnatal after 1 min and 5 min between two groups(p>0.05). Intragroup comparsion:There was significiant degree of elevation in the post-operative levels of uric acid,creatinine and urea than the elevation seen pre-operatively.Compasion between groups:Except for the 48 hour post-operative uric and levels of study group which were lower than that of the control group,after the 48 hour time period there was no significant different in the three indices among the two groups.More over the study group did not show any significant renal funtion impairment;the uric acid,creatinine and urea levels were within the normal limits.Conclusion: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 loos,blood transfusion,the rate of hysterectomy without significant renal function impairment.Intra-operative abdominal aortic occlusion is a safe technique for patients having pernicious placenta previa with placenta accreta undergoing cesarean section.

Key words: pernicious placenta previa;estimated blood loss;intra-aortic abdominal aortic balloon;the rate of hysterectomy;renal function