腹主动脉远端预置球囊阻断治疗凶险型前置胎盘的有效性与安全性

目的:分析凶险型前置胎盘产妇术前运用腹主动脉远端预置球囊的安全性和有效性。 方法:连续选择2012年5月至2017年5月诊断凶险型前置胎盘产妇共68例，随机分为对照组和观察组各34例，对照组仅采用剖宫产术，观察组术前采用腹主动脉远端预置球囊。对比妊娠结局。 结果:观察组出血量、输入红细胞悬液均显著少于对照组，泌尿系统和肠道损伤、子宫切除、感染、急性肾衰发生率分别为5.9%（2/34）、2.9%（1/34）、5.9%（2/34）、2.9%（1/34），均显著低于对照组的23.5%（8/34）、17.6%（6/34）、26.5%（9/34）、20.6%（7/34），差异有统计学意义（P<0.05），但两组患者的死亡率、腹腔积血发生率无显著差异（P>0.05）。观察组新生儿1 min和5 min Apgar评分显著高于对照组（P<0.05）。随访6个月观察组产后出血1例，经保守治疗后好转；感染1例，经积极、有效抗生素治愈；下肢动静脉血栓3例，未出现严重下肢缺血坏死、静脉血栓脱落等并发症。术前介入操作1~5 min，平均（2.3±0.9） min，总计放射量45~95 mGy，平均（78.4±16.3） mGy。 结论:凶险型前置胎盘产妇术前运用腹主动脉远端预置球囊有较好的安全性和有效性。

Effectiveness and safety of balloon occlusion in distal abdominal aorta for parturient women with pernicious placenta previa

Objective To study the effectiveness and safety of balloon occlusion in distal abdominal aorta before the caesarean section for parturient woman with pernicious placenta previa. Methods A total of 68 consecutive parturient women diagnosed with pernicious placenta previa between May 2012 and May 2017 were enrolled and then randomly divided into control group and observation group, with 34 cases in each group. The patients in control group received only caesarean section, while those in observation group were treated with balloon occlusion in distal abdominal aorta before caesarean section. The differences in pregnancy outcomes were compared. Results The amount of bleeding and red blood cell suspension infusion in observation group were significantly lower than those in control group. The incidences of urinary tract and intestinal injury, hysterectomy, infection, acute renal failure in observation group were 5.9% (2/34), 2.9% (1/34), 5.9% (2/34) and 2.9% (1/34), respectively, significantly lower than 23.5% (8/34), 17.6% (6/34), 26.5% (9/34) and 20.6% (7/34) in control group, with statistically significant differences (P<0.05). The comparison between two groups didn’t showed any statistical differences in mortality and the incidence of hemoperitoneum (P>0.05). The 1-min and 5-min Apgar scores of the newborns in observation group was significantly higher than those in control group (P<0.05). Followed-up for 6 months after caesarean section, in operation group, 1 case of postpartum hemorrhage were improved after conservative treatment, and 1 case was infected and then cured by active and effective antibiotics, and 3 cases had lower extremity arteriovenous thrombosis, without developing any severe ischemic necrosis of the lower extremities or venous thrombosis. The duration of preoperative intervention was 1-5 min, with an average of (2.3±0.9) min, and the total amount of radiotherapy dose was 45-95 mGy, with an average of (78.4±16.3) mGy. Conclusion Applying balloon occlusion in distal abdominal aorta before the caesarean section for parturient woman with pernicious placenta previa is proved to be effective and safe.