中华产科急救电子杂志
中華產科急救電子雜誌
중화산과급구전자잡지
Chinese Journal of Obstetric Emergency
2015年
2期
110-113
,共4页
余琳%匡丽云%苏春宏%陈艳红%孙斌%陈敦金
餘琳%劻麗雲%囌春宏%陳豔紅%孫斌%陳敦金
여림%광려운%소춘굉%진염홍%손빈%진돈금
前置胎盘%引产%子宫%栓塞,治疗性
前置胎盤%引產%子宮%栓塞,治療性
전치태반%인산%자궁%전새,치료성
placenta previa%uterus%embolization,therapeutic%induced labor
目的：探讨子宫动脉栓塞术在中孕期中央性前置胎盘状态引产中的预防出血效果及不良反应。方法采用回顾性研究方法对2011年1月至2014年12月在广州医科大学附属第三医院行中孕期中央性前置胎盘状态引产的79例患者临床资料进行分析。将羊膜腔注射乳酸依沙吖啶注射液联合口服米非司酮，同时使用子宫动脉栓塞术引产的29例患者作为栓塞组（其中孕20～27＋6周18例，＜20周11例）；将只采用羊膜腔注射乳酸依沙吖啶注射液联合口服米非司酮的50例患者作为对照组（其中孕20～27＋6周20例，＜20周30例）；分别对两组患者的引产时间、出血量、术后发热率、术后疼痛强度和月经恢复时间等进行比较。结果（1）引产时间：孕20～27＋6周患者中栓塞组除1例因引产失败转为剖宫取胎外，其余17例为（45.94±5.80）h，对照组为（41.23±7.59）h（t＝1.85，P＜0.05）；两组＜20周患者引产时间分别为（49.36±7.80） h和（41.23±13.85） h（ t＝1.83， P＜0.05）差异有统计学意义。（2）出血量：20～27＋6周栓塞组出血量少于对照组，分别为（294±60） ml和（356±81）ml（t＝2.64，P＜0.01），差异有统计学意义；两组＜20周患者出血量差异无统计学意义。（3）栓塞术后疼痛评分：20～27＋6周两组患者分别为（8.70±0.90）分和（2.11±0.50）分（ t＝13.67，P＜0.01）差异有统计学意义；＜20孕周两组患者分别为（7.27±1.80）分和（1.65±0.48）分（t＝13.39， P＜0.01），差异有统计学意义。（4）术后发热：20～27＋6周两组患者分别为64.71％和5％（ t ＝18.26，P＜0.01），＜20周两组患者分别为63.64％和6.67％（t＝11.25， P＜0.01），差异有统计学意义。结论（1）子宫动脉栓塞术对于孕周20～27＋6周的胎盘前置状态引产出血有积极的预防作用，但对孕周＜20周的前置胎盘状态引产预防出血意义不大。（2）子宫动脉栓塞术可能会延长引产时间，增加产后疼痛强度及发热率，临床应用需谨慎。（3）在中孕期前置胎盘状态引产手术中，娴熟的产科处理技术对术中预防和减少出血可以起到积极的作用。
目的：探討子宮動脈栓塞術在中孕期中央性前置胎盤狀態引產中的預防齣血效果及不良反應。方法採用迴顧性研究方法對2011年1月至2014年12月在廣州醫科大學附屬第三醫院行中孕期中央性前置胎盤狀態引產的79例患者臨床資料進行分析。將羊膜腔註射乳痠依沙吖啶註射液聯閤口服米非司酮，同時使用子宮動脈栓塞術引產的29例患者作為栓塞組（其中孕20～27＋6週18例，＜20週11例）；將隻採用羊膜腔註射乳痠依沙吖啶註射液聯閤口服米非司酮的50例患者作為對照組（其中孕20～27＋6週20例，＜20週30例）；分彆對兩組患者的引產時間、齣血量、術後髮熱率、術後疼痛彊度和月經恢複時間等進行比較。結果（1）引產時間：孕20～27＋6週患者中栓塞組除1例因引產失敗轉為剖宮取胎外，其餘17例為（45.94±5.80）h，對照組為（41.23±7.59）h（t＝1.85，P＜0.05）；兩組＜20週患者引產時間分彆為（49.36±7.80） h和（41.23±13.85） h（ t＝1.83， P＜0.05）差異有統計學意義。（2）齣血量：20～27＋6週栓塞組齣血量少于對照組，分彆為（294±60） ml和（356±81）ml（t＝2.64，P＜0.01），差異有統計學意義；兩組＜20週患者齣血量差異無統計學意義。（3）栓塞術後疼痛評分：20～27＋6週兩組患者分彆為（8.70±0.90）分和（2.11±0.50）分（ t＝13.67，P＜0.01）差異有統計學意義；＜20孕週兩組患者分彆為（7.27±1.80）分和（1.65±0.48）分（t＝13.39， P＜0.01），差異有統計學意義。（4）術後髮熱：20～27＋6週兩組患者分彆為64.71％和5％（ t ＝18.26，P＜0.01），＜20週兩組患者分彆為63.64％和6.67％（t＝11.25， P＜0.01），差異有統計學意義。結論（1）子宮動脈栓塞術對于孕週20～27＋6週的胎盤前置狀態引產齣血有積極的預防作用，但對孕週＜20週的前置胎盤狀態引產預防齣血意義不大。（2）子宮動脈栓塞術可能會延長引產時間，增加產後疼痛彊度及髮熱率，臨床應用需謹慎。（3）在中孕期前置胎盤狀態引產手術中，嫻熟的產科處理技術對術中預防和減少齣血可以起到積極的作用。
목적：탐토자궁동맥전새술재중잉기중앙성전치태반상태인산중적예방출혈효과급불량반응。방법채용회고성연구방법대2011년1월지2014년12월재엄주의과대학부속제삼의원행중잉기중앙성전치태반상태인산적79례환자림상자료진행분석。장양막강주사유산의사아정주사액연합구복미비사동，동시사용자궁동맥전새술인산적29례환자작위전새조（기중잉20～27＋6주18례，＜20주11례）；장지채용양막강주사유산의사아정주사액연합구복미비사동적50례환자작위대조조（기중잉20～27＋6주20례，＜20주30례）；분별대량조환자적인산시간、출혈량、술후발열솔、술후동통강도화월경회복시간등진행비교。결과（1）인산시간：잉20～27＋6주환자중전새조제1례인인산실패전위부궁취태외，기여17례위（45.94±5.80）h，대조조위（41.23±7.59）h（t＝1.85，P＜0.05）；량조＜20주환자인산시간분별위（49.36±7.80） h화（41.23±13.85） h（ t＝1.83， P＜0.05）차이유통계학의의。（2）출혈량：20～27＋6주전새조출혈량소우대조조，분별위（294±60） ml화（356±81）ml（t＝2.64，P＜0.01），차이유통계학의의；량조＜20주환자출혈량차이무통계학의의。（3）전새술후동통평분：20～27＋6주량조환자분별위（8.70±0.90）분화（2.11±0.50）분（ t＝13.67，P＜0.01）차이유통계학의의；＜20잉주량조환자분별위（7.27±1.80）분화（1.65±0.48）분（t＝13.39， P＜0.01），차이유통계학의의。（4）술후발열：20～27＋6주량조환자분별위64.71％화5％（ t ＝18.26，P＜0.01），＜20주량조환자분별위63.64％화6.67％（t＝11.25， P＜0.01），차이유통계학의의。결론（1）자궁동맥전새술대우잉주20～27＋6주적태반전치상태인산출혈유적겁적예방작용，단대잉주＜20주적전치태반상태인산예방출혈의의불대。（2）자궁동맥전새술가능회연장인산시간，증가산후동통강도급발열솔，림상응용수근신。（3）재중잉기전치태반상태인산수술중，한숙적산과처리기술대술중예방화감소출혈가이기도적겁적작용。
Objective To evaluate the effects of uterine artery embolization on preventing the pregnancy with complete placenta previa hemorrhage during induced labor in second trimester and its adverse effects .Methods We retrospectively analyzed 79 cases of labor induction on pregnancy with complete placenta previa during second trimester , who were admitted to the third affiliated hospital of Guangzhou medical university during January 2011 to December 2014.There were divided into embolization group and control group .In embolization group , 29 patients were induced labored by using rivanol and mifepristone.On the same time, they were performed uterine artery embolization (UAE).18 cases were 20-27 +6 gestational weeks and 11 cases were less than 20 gestational weeks .In control group , 50 patients were induced labored by using rivanol and mifepristone .20 cases were 20-27 +6 gestational weeks and 30 cases were less than 20 gestational weeks .The timing of labor induction , the number of loss bleeding , the rate of fever , the pain degree and the recovery phase of menstruation were compared between embolization group and control group .Results ( 1 ) Excepted one performed cesarean section due to fail of induced labor, the timing of induced labor in 20-27 +6 gestational weeks was (49.36 ±7.80) hour in embolization group and was ( 41.23 ±7.59 ) hour in control group .Under 20 gestational weeks , the timing of induced labors was (49.36 ±7.80) h and (41.23 ±13.85) h in embolization group and control group , respectively. Compared in the timing of induced labored between two groups , there was significant difference .( 2 ) Compared in the number of loss bleeding in 20-27 +6 gestational weeks between two groups , 294 ±60 ml and 356 ±81 ml were respectively in embolization group and control group , which was significant difference.There war not significant difference in less than 20 gestational weeks.(3)Compared in the pain degree in 20 -27 +6 gestational weeks between two groups , the score was respectively 8.70 ±0.90 and 2.11 ±0.50 in embolization group and control group , which was significant difference .Compared in the pain degree in less than 20 gestational weeks , the score was 7.27 ±1.80 and 1.65 ±0.48 respectively in embolization group and control group , which was significant difference .(4) The rate of fever was 61.11%in 20 ~27 +6 gestational weeks of embolization group and 5% in control group, which was significant difference .Compared in less than 20 gestational weeks between two groups , there was respectively 63.63%and 6.67%, which also were significantly difference .Conclusions (1) UAE played a positive role on preventing hemorrhage due to central placenta previa in more than 20 gestational weeks .But there was not on less than 20 gestational weeks.(2) UAE could prolong the time of labor induction , increase the pain degree and the rate of fever .So we used UAE cautiously .(3) In induced labor with central placenta previa during second trimester , adept skill played a positive role on preventing and decreasing hemorrhage .
