中国卫生标准管理
中國衛生標準管理
중국위생표준관리
CHINA HEALTH STANDARD MANAGEMENT
2015年
19期
25-26
,共2页
产后出血%凶险型前置胎盘%介入治疗%剖宫产
產後齣血%兇險型前置胎盤%介入治療%剖宮產
산후출혈%흉험형전치태반%개입치료%부궁산
Postpartum hemorrhage%Dangerous type of placenta previa%Interventional therapy%Cesarean delivery
目的：评价双侧股动脉预置管联合剖宫产治疗凶险型前置胎盘的临床效果，总结治疗经验。方法2011年2月～2014年8月收治18例凶险型前置胎盘产妇，11例急诊、7例择期，均登记注册。介入科会诊，局麻，Selding技术穿刺右股动脉，插入5F导管至腹主动脉下段，置导管鞘，行剖宫产。取出胎儿及其附件后，纱条止血，造影下将导管插入出血血管，以2 mm×2 mm×2 mm明胶海绵颗粒栓塞，钝锐性结合剥离胎盘，局部缝扎、宫缩剂止血。术后复查，若无活动性出血拔管，肌注MTX促胎盘组织萎缩、肌化，随访6个月，复查HCG，复行彩色血流超声。结果无死亡、严重并发例。出血1800～3700 ml、平均（2422±834）ml，输注红细胞悬液4.0～12.0 U、血浆400～1200 ml、住院总日数5～21 d、平均（11.8±6.4）d、新生儿体重（2583±866）g，Apgar 1min（9.6±0.8）分、Apgar 5 min（8.8±1.8）分。术后出现腰背痛1例，无再出血、HCG异常。结论在严格掌握适应证、禁忌证条件下，双侧股动脉预置管联合剖宫产治疗凶险型前置胎盘效果较好，有助于保留子宫，减少出血量，降低风险。
目的：評價雙側股動脈預置管聯閤剖宮產治療兇險型前置胎盤的臨床效果，總結治療經驗。方法2011年2月～2014年8月收治18例兇險型前置胎盤產婦，11例急診、7例擇期，均登記註冊。介入科會診，跼痳，Selding技術穿刺右股動脈，插入5F導管至腹主動脈下段，置導管鞘，行剖宮產。取齣胎兒及其附件後，紗條止血，造影下將導管插入齣血血管，以2 mm×2 mm×2 mm明膠海綿顆粒栓塞，鈍銳性結閤剝離胎盤，跼部縫扎、宮縮劑止血。術後複查，若無活動性齣血拔管，肌註MTX促胎盤組織萎縮、肌化，隨訪6箇月，複查HCG，複行綵色血流超聲。結果無死亡、嚴重併髮例。齣血1800～3700 ml、平均（2422±834）ml，輸註紅細胞懸液4.0～12.0 U、血漿400～1200 ml、住院總日數5～21 d、平均（11.8±6.4）d、新生兒體重（2583±866）g，Apgar 1min（9.6±0.8）分、Apgar 5 min（8.8±1.8）分。術後齣現腰揹痛1例，無再齣血、HCG異常。結論在嚴格掌握適應證、禁忌證條件下，雙側股動脈預置管聯閤剖宮產治療兇險型前置胎盤效果較好，有助于保留子宮，減少齣血量，降低風險。
목적：평개쌍측고동맥예치관연합부궁산치료흉험형전치태반적림상효과，총결치료경험。방법2011년2월～2014년8월수치18례흉험형전치태반산부，11례급진、7례택기，균등기주책。개입과회진，국마，Selding기술천자우고동맥，삽입5F도관지복주동맥하단，치도관초，행부궁산。취출태인급기부건후，사조지혈，조영하장도관삽입출혈혈관，이2 mm×2 mm×2 mm명효해면과립전새，둔예성결합박리태반，국부봉찰、궁축제지혈。술후복사，약무활동성출혈발관，기주MTX촉태반조직위축、기화，수방6개월，복사HCG，복행채색혈류초성。결과무사망、엄중병발례。출혈1800～3700 ml、평균（2422±834）ml，수주홍세포현액4.0～12.0 U、혈장400～1200 ml、주원총일수5～21 d、평균（11.8±6.4）d、신생인체중（2583±866）g，Apgar 1min（9.6±0.8）분、Apgar 5 min（8.8±1.8）분。술후출현요배통1례，무재출혈、HCG이상。결론재엄격장악괄응증、금기증조건하，쌍측고동맥예치관연합부궁산치료흉험형전치태반효과교호，유조우보류자궁，감소출혈량，강저풍험。
Objective To evaluate the bilateral femoral artery preset tube joint cesarean delivery for treatment of dangerous type of placenta previa,sum up treatment experience.Methods From February 2011 to August 2014,to select 18 cases of dangerous type of placenta previa maternal, 11 cases of emergency,7 cases undergoing emergency,and all registered.Interventional radiology consultation,given Local anesthesia,and used the selding technique to puncture right femoral artery.Insert a 5F catheter into the next section of the abdominal aorta,placed in the catheter sheath,then begin to produce.After removal of the fetus and its annex,with gauze to stop bleeding,contrast conditions,inserted the catheter into the bleeding vessel,embolizated with 2 mm × 2 mm ×2 mm gelatin sponge particles.Blunt sharp combined with the release of placenta,local suture ligation combined with oxytocin to stop the bleeding.Postoperative review,if there was no active bleeding,extubation. Intramuscular injection of MTX promoting placenta tissue atrophy,muscle,then,followed up for 6 months,reviewed HCG and CDFI. ResultsNo death and serious complications.The amount of bleeding was between 1800 and 3700 ml,the average bleeding volume was (2422 + 834) ml.The amount of red blood cell suspension was between 4 U and 12 U,and the plasma volume was between 400 and 1200 ml.The total number of hospital days was between 5 d and 21 d,the average number was (11.8±6.4)days,the average weight of newborns was (2583 + 866) g,the average 1min Apgar score was (9.6 + 0.8) pionts,and the average 5min Apgar score was (9.6 + 0.8)pionts.There were 1 cases of low back pain after operation.No patient with bleed and HCG abnormal.ConclusionUnder the condition of strictly grasp the indications, contraindications,bilateral femoral artery preset tube type of placenta previa with cesarean delivery therapy disaster is good to the uterus,less blood loss,and reduce the risk.
