【摘要】 目的探讨超声引导腹主动脉下段球囊阻断在凶险性前置胎盘剖宫产术中的应用效果。方法 2017年1月～2018年12月对25例凶险性前置胎盘产妇采用超声引导腹主动脉下段球囊阻断术控制剖宫产术中出血。术前由血管外科医师在超声引导下将球囊放置于髂动脉分叉上方腹主动脉,术中胎儿娩出后立即充盈球囊阻断腹主动脉,再行胎盘剥离及胎盘剥离面缝合。记录产妇术中球囊阻断时间、手术时间、术中总出血量、输血量、是否保留子宫、新生儿Apgar评分、住院时间及并发症情况。结果 25例产妇均成功置入球囊导管并完成手术,术中球囊阻断时间平均(16.5±9.3)min,手术时间平均(62.7±14.5)min,出血量平均(528±203)ml,住院时间平均(7.2±2.4)d。4例(16%)予输血,平均输血量(220±138)ml; 1例(4%)出血1 500 ml行子宫切除。新生儿Apgar评分:1 min为(8.9±0.5)分, 5 min为(9.6±0.2)分。无产妇及胎儿死亡,均未发生下肢动脉血栓、神经损伤、盆腔感染等并发症。结论凶险性前置胎盘产妇行剖宫产术中采用超声引导下腹主动脉下段球囊阻断术可有效控制术中出血,降低子宫切除率,避免对胎儿的放射损伤,值得推广应用。更多还原

【Abstract】 Objective To explore the clinical value of ultrasound-guided lower abdominal aorta balloon occlusion during cesarean section of the patients with pernicious placenta previa. Methods From January 2017 to December 2018, a total of 25 patients with pernicious placenta previa in our hospital were performed cesarean section under ultrasound-guided lower abdominal aorta balloon occlusion. Before the cesarean section, the balloon catheter was inserted into the abdominal aortic by vascular surgeon under ultrasound guided. During the operation, the delivery of the fetal was accompanied by an immediate filling of the balloon to block the abdominal aorta, the separation of placenta and the suturing of the placental abscission surface were performed correspondingly. The balloon block time, operation time, blood loss, blood transfusion amount, hysterectomy rate, neonatal Apgar score, hospital stays and related complications were recorded. Results All of the 25 cases placed the balloon catheter successfully and completed the operation. The average time of balloon blocking was(16.5±9.3) min, the average operation time was(62.7±14.5) min,the average blood loss volume was( 528 ± 203) ml,and the average hospital stays were( 7.2 ± 2.4) days.4 cases( 16%) received blood transfusion with the average amount of( 220±138) ml. One case( 4%) was performed hysterectomy due to bleeding of 1 500 ml. The Apgar score was 8.9±0.5 at 1 min and 9.6±0.2 at 5 min. There was no maternal and fetal death occurred. No lower extremity arterial thrombosis,nerve injury and pelvic infection were found during and after the surgery. Conclusion Ultrasound-guided lower abdominal aorta balloon occlusion during cesarean section for the patients with pernicious placenta previa can effectively reduce the intra-operative bleeding,decrease the hystrectomy rate and avoid radiation damage to the fetus.更多还原