适时腹主动脉球囊阻断术在凶险型前置胎盘伴胎盘植入产妇剖宫产术中的应用价值研究

目的　探讨适时腹主动脉球囊阻断术在凶险型前置胎盘伴胎盘植入产妇剖宫产术中的应用价值。方法　选取2013年1月—2017年7月于南通市第一人医院妇产科行剖宫产分娩的符合纳入标准的凶险型前置胎盘伴胎盘植入产妇28例。根据产妇自愿原则进行分组，其中14例产妇选择剖宫产术前适时应用腹主动脉球囊阻断术（球囊阻断术组），14例产妇要求直接剖宫产术（对照组）。比较两组产妇手术时间、术中出血量、总共输血量、手术前后血红蛋白水平差值、分娩孕周、术后住院时间、术后活化部分凝血活酶时间（APTT）、术后D-二聚体水平、子宫切除率、新生儿窒息率。结果　球囊阻断术组产妇术中出血量、总共输血量少于对照组，手术前后血红蛋白水平差值小于对照组（P<0.05）；两组产妇手术时间比较，差异无统计学意义（P>0.05）。两组产妇分娩孕周、术后APTT、术后D-二聚体水平比较，差异无统计学意义（P>0.05）；球囊阻断术组产妇术后住院时间短于对照组，子宫切除率、新生儿窒息率低于对照组（P<0.05）。结论　适时地在剖宫产术前应用腹主动脉球囊阻断术，可减少凶险型前置胎盘伴胎盘植入产妇剖宫产术中出血量、总共输血量及子宫切除率，改善妊娠结局，但球囊释放后仍有产后出血的风险，需联合子宫动脉栓塞术等介入治疗来进一步改善凶险型前置胎盘伴胎盘植入产妇的妊娠结局。

Temporary Balloon Occlusion of the Abdominal Aorta for Women with Pernicious Placenta Previa and Placenta Accreta Undergoing Cesarean Delivery

Objective　To investigate the effectiveness of temporary balloon occlusion of the abdominal aorta（TBOAA） in the treatment of women with pernicious placenta previa and placenta accreta undergoing cesarean delivery.Methods　We enrolled 28 women with pernicious placenta previa and placenta accrete undergoing cesarean delivery from Department of Obstetrics and Gynecology，Nantong First People's Hospital from January 2013 to July 2017，including 14 volunteered to use TBOAA before the delivery（TBOAA group），and 14 did not（control group）.We collected and compared two groups' data about duration of cesarean delivery，blood loss during cesarean delivery，total transfusion volume，difference between the hemoglobin level before and after cesarean delivery，gestational weeks，duration of hospitalization，activated partial thromboplastin time（APTT） and D-dimer levels after cesarean delivery，incidence of hysterectomy and neonatal asphyxia.Results　Compared with the control group，the average blood loss during cesarean delivery，average total transfusion volume，and average difference between the hemoglobin level before and after cesarean delivery were all less in the TBOAA group（P<0.05）.Moreover，TBOAA group demonstrated shorter duration of hospitalization after cesarean delivery，and lower　incidence of hysterectomy and neonatal asphyxia（P<0.05）.However，both groups showed no significant differences in duration of cesarean delivery，gestational weeks，APTT and levels of D-dimer after cesarean delivery（P>0.05）.Conclusion　Use of TBOAA before the cesarean delivery could reduce the blood loss during the delivery and total transfusion volume，decrease the incidence of hysterectomy and improve the outcome.However，after the removal of the balloon，there might be still a risk of bleeding，and uterine artery embolization and other interventions might be needed to improve the outcome.