CAJ | 학술논문

目的通过分析行产时胎儿手术的母体预后,探讨产时胎儿手术的可行性、安全性及预防产后出血,保证母体良好预后的有效措施.方法回顾性分析2008年8月至2009年10月我院成功施行产时胎儿手术的10例患者[产时胎儿手术组(IFO组),n=10]术中及术后24 h内出血量,术前和术后24 h的血红蛋白水平、宫缩情况、产褥感染的发生情况,产后42 d随访情况并与同期因拒绝试产行择期剖宫产手术的10例健康孕妇(对照组)进行各项指标比较.结果两组惠者的子宫复旧情况均正常,均无早期及晚期产后出血及产褥感染发生.IFO组母体术中出血量、术后24 h及术中+术后24 h总出血量、术前和术后及产后42 d复查的血红蛋白浓度与对照组相比均无统计学差异(P＞0.05).IFO组剖宫产术时间为(66.40±53.40)min,与对照组(34.50±4.97)min相比未见统计学差异(P＜0.05).术中出血量、术后24 h内产后出血量及术中+术后24 h出血量均与患者的年龄和孕周无相关(P＞0.05),而与剖宫产术时间呈正相关(r=0.458,P=0.021),其线性回归方程为:Y(ml)=172.68+1.342X.结论产时胎儿手术对于母体的子宫复旧无明显影响,不增加产后出血量及产褥感染发生率,对母体是安全的.采用积极有效的预防措施可以使产时手术的孕产妇的产后出血量并不明显超过普通剖宫产术,积极提高胎儿手术技术,尽量缩短产时手术时间也是预防母体产后出血的一项重要措施.
목적 통과분석행산시태인수술적모체예후,탐토산시태인수술적가행성、안전성급예방산후출혈,보증모체량호예후적유효조시.방법 회고성분석2008년8월지2009년10월아원성공시행산시태인수술적10례환자[산시태인수술조(IFO조),n=10]술중급술후24 h내출혈량,술전화술후24 h적혈홍단백수평、궁축정황、산욕감염적발생정황,산후42 d수방정황병여동기인거절시산행택기부궁산수술적10례건강잉부(대조조)진행각항지표비교.결과 량조혜자적자궁복구정황균정상,균무조기급만기산후출혈급산욕감염발생.IFO조모체술중출혈량、술후24 h급술중+술후24 h총출혈량、술전화술후급산후42 d복사적혈홍단백농도여대조조상비균무통계학차이(P＞0.05).IFO조부궁산술시간위(66.40±53.40)min,여대조조(34.50±4.97)min상비미견통계학차이(P＜0.05).술중출혈량、술후24 h내산후출혈량급술중+술후24 h출혈량균여환자적년령화잉주무상관(P＞0.05),이여부궁산술시간정정상관(r=0.458,P=0.021),기선성회귀방정위:Y(ml)=172.68+1.342X.결론 산시태인수술대우모체적자궁복구무명현영향,불증가산후출혈량급산욕감염발생솔,대모체시안전적.채용적겁유효적예방조시가이사산시수술적잉산부적산후출혈량병불명현초과보통부궁산술,적겁제고태인수술기술,진량축단산시수술시간야시예방모체산후출혈적일항중요조시.
Objective To investigate the feasibility,security,indication and prophylactic measures of postpartum hemorrhage during the fetalintrapartum operation by analyze the maternal prognosis after intrapartum fetal operation(IFO) performed.Methods We performed a retrospective evaluation of 10 cases that has been performed intrapartum fetal operation(IFO group,n=10) successfully between August 2008 and October 2009 at Department of Obstetrics and Gynecology,Shengjing Hospital,China Medical University.Healthy pregnant women(n=10) were chosen as control group,who received Caesarean section for refusing to vaginal delivery.Between the two groups,we compared the indexes including blood lose during the operation and 24 hours post-operation,the hemoglobin level pre-operation and 24 hours post-operation,the involution of uterus,the puerperal infection,and the follow-up at 42 days post-operation.Results Good involution,no primary and secondary postpartum hemorrhage and no puerperal infection were found in both of the 2 groups.Intra-operation,24 hours post-operation and the total volumes of blood lose,the hemoglobin level before operation,24 hours post-operation and 42 days post-operation had no statistic significant difference between the IFO group and control group(P>0.05).No significant difference was found in the operation time between IFO group and the control group(66.40±53.40 minutes and 34.50±4.97 minutes,respectively.Intra-operation,24 hours post-operation and the total volume of blood lose had no relation to the maternal age and gestational weeks(P>0.05).The blood lose of intra-operation in IFO group had positive linear correlation to the operation time.(Pearson relation coefficient R=0.458,.P=0.021).The linear recurrence equation was:the volumes of blood lose intra-operation(ml)=172.68+1.342x(operation time).Conclusion IFO was safe to the mother.It did not affect the involution of uterus and could not increase the blood lose of postpartum and the puerperal infection morbidity.Through the effective measures of preventing postpartum hemorrhage,the postpartum blood lose of the patients that performed intrapartum fetal operation could be no more than that of the patients that had normal Caesarean section.Improving the technique of the intrapartum fetus operation and shortening the operation time are important to prevent postpartum hemorrhage.