凶险性前置胎盘腹主动脉球囊阻断下剖宫产术子宫切除的相关影响因素及母婴结局研究

目的 探讨凶险性前置胎盘腹主动脉球囊阻断下剖宫产术子宫切除相关影响因素，并分析对母儿结局的影响。方法 选择2015年2月~2017年7月在重庆医科大学附属第一医院因诊断为凶险性前置胎盘而行腹主动脉球囊阻断下剖宫产术的产妇146例，观察组为切除子宫的产妇共22例，对照组为未切除子宫的产妇共124例。对临床资料进行分析，采用非条件Logistic回归分析子宫切除的相关影响因素。结果 术后行子宫动脉栓塞是子宫切除的保护因素（B值-1.968，OR 0.355，95%CI 0.239~0.528），而人工流产次数（B值0.929，OR 1.307，95%CI 1.054~1.655）和胎盘植入情况（B值1.622，OR 1.204，95%CI 1.103~1.305）是其危险因素，均与子宫切除密切相关（P＜0.05）。观察组术中出血量、输血量大于对照组，差异具有统计学意义（P＜0.05）。观察组手术时间、住院日长于对照组，差异具有统计学意义（P＜0.05）。观察组术后转入ICU率高于对照组，差异具有统计学意义（P＜0.05）。观察组患者1 min Apgar评分低于对照组，差异具有统计学意义（P＜0.05）。结论 人工流产次数、胎盘植入情况是评估能否保留子宫的重要因素。需要切除子宫者术中出血量大，术后需转入ICU治疗几率高，对新生儿结局无广泛影响。

The Influencing Factors of the Hysterectomy for Cesarean Section under the Blocking of the Dangerous Placenta Previa Placenta and the Results of Mother and Child

Abstract:Objective To investigate the influencing factors of hysterectomy for cesarean section under the risk of dangerous placenta previa placental aortic balloon occlusion,and to analyze the effect on mother and child outcome.Methods 146 women who underwent abdominal cesarean section with abdominal aorta balloon obstruction were selected from February 2015 to July 2017 in the First Affiliated Hospital of Chongqing Medical University for diagnosis of dangerous placenta previa.The observation group was a total of 22 cases of maternal uterus resection,and the control group was a total of 124 cases without uterus resection.The clinical data were analyzed and non-conditional Logistic regression was used to analyze the relevant factors of hysterectomy.Results Postoperative uterine artery embolization was a protective factor for hysterectomy(B value-1.968,OR 0.355,95% CI 0.239-0.528),while the number of abortions (B value 0.929,OR 1.307,95% CI 1.054-1.655)and Placenta implantation(B value 1.622,OR 1.204,95% CI 1.103 to 1.305)was a risk factor and was closely related to hysterectomy(P<0.05).The blood loss and blood transfusion volume in the observation group were greater than those in the control group,and the difference was statistically significant(P<0.05).The time of operation and the length of hospital stay in the observation group were longer than those in the control group,and the difference was statistically significant(P<0.05).The rate of ICU transfer in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).The 1-minute Apgar score of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion The number of abortions and placenta accreta are important factors in evaluating uterine retention.The patients who needed hysterectomy had a large amount of bleeding during operation and had a high chance of transferring to ICU after operation,which had no extensive influence on the neonatal outcome.