标题：腹主动脉预置球囊辅助凶险性前置胎盘伴胎盘植入剖宫产的临床应用研究

      作者：宋瑞香，肖飒，苗红艳    三门峡市中心医院产科，河南 三门峡 472000

      卷次： 2024年35卷6期

      【摘要】 目的 探讨腹主动脉预置球囊术对凶险性前置胎盘(PPP)伴胎盘植入剖宫产产妇应激反应、凝血功能及母婴结局的影响。方法 选取2021年1月至2023年6月三门峡市中心医院收治的62例PPP伴胎盘植入产妇，按照随机数表法分为观察组和对照组各31例。两组产妇均行剖宫产术，对照组行髂内动脉预置球囊术，研究组行腹主动脉预置球囊术。比较两组产妇的手术指标、手术前后的应激反应指标[肾上腺素(E)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、去甲肾上腺素(NE)]、凝血功能[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]、血红蛋白(Hb)、红细胞压积(HCT)水平，同时比较两组新生儿的相关情况及产妇的子宫切除率和并发症发生率。结果 研究组产妇的手术时间、透视耗时、住院时间分别为(111.63±15.59) min、(15.67±3.27) s、(6.04±0.53) d，明显短于对照组的(128.75±20.03) min、(28.96±5.11) s、(6.65±0.74) d，放射剂量、术中与术后24 h出血量、术中输血量分别为(4.21±0.74) mGy、(752.31±153.66) mL、(135.47±20.37) mL、(357.92±32.40) mL，明显少于对照组的(15.63±2.39) mGy、(1 026.47±212.52) mL、(328.19±38.92) mL、(950.30±85.61) mL，差异均有统计学意义(P<0.05)；术后24 h，研究组产妇的血清Cor、ACTH、E、NE水平明显低于对照组，APTT、TT、PT、FIB、Hb、HCT明显高于对照组，差异均有统计学意义(P<0.05)；出生 1 min、5 min，研究组新生儿Apgar评分分别为(9.02±0.27)分、(9.52±0.24)分，明显高于对照组的(8.74±0.33)分、(9.13±0.30)分，新生儿窒息率为0，明显低于对照组的19.35%，差异均有统计学意义(P<0.05)；研究组产妇的子宫切除率、并发症发生率分别为 6.45%、6.45%，明显低于对照组的29.03%、32.26%，差异均有统计学意义(P<0.05)。结论 腹主动脉预置球囊可减少PPP伴胎盘植入剖宫术中放射剂量、出血量及输血量，减少应激反应，改善凝血功能，促进术后早期恢复，同时提高手术安全性，改善新生儿分娩结局，降低窒息与子宫切除风险。
      【关键词】 凶险性前置胎盘；胎盘植入；腹主动脉预置球囊术；髂内动脉预置球囊术；应激反应；凝血功能；新生儿情况；子宫切除率；并发症
      【中图分类号】 R719.8 【文献标识码】 A 【文章编号】 1003—6350（2024）06—0804—06

Clinical application of prepositioned abdominal aorta balloon in assisting cesarean section for dangerous placentaprevia accompanied with placenta implantation.
SONG Rui-xiang, XIAO Sa, MIAO Hong-yan. Department ofObstetrics, Sanmenxia Central Hospital, Sanmenxia 472000, Henan, CHINA
【Abstract】 Objective To investigate the effects of prepositioned abdominal aorta balloon on stress response,coagulation function, and maternal-fetal outcomes in patients undergoing cesarean section for placenta previa (PPP) ac-companied by placenta implantation. Methods Sixty-two patients of PPP with placenta implantation admitted to San-menxia Central Hospital from January 2021 to June 2023 were selected and randomly divided into an observation groupand a control group according to the random number table method, each with 31 cases. Both groups of patients under-went cesarean section. Patient in the control group underwent internal iliac artery balloon prepositioning, and those in thestudy group underwent abdominal aortic balloon prepositioning. The surgical indicators of the two groups of parturientswere compared, as well as the stress response indicators before and after surgery [adrenaline (E), adrenocorticotropic hor-mone (ACTH), cortisol (Cor), norepinephrine (NE)], coagulation function [prothrombin time (PT), thrombin time(TT), activated partial thromboplastin time (APTT), fibrinogen (FIB)], hemoglobin (Hb), and hematocrit (HCT)levels, the related conditions of the two groups of newborns, and the maternal uterine resection rate and complica-tion rate. Results The operation time, fluoroscopy time, and length of hospital stay in the study group were (111.63±15.59) min, (15.67±3.27) s, and (6.04±0.53) d, respectively, which were significantly shorter than (128.75±20.03) min,(28.96±5.11) s, and (6.65±0.74) d of the control group; the radiation dose, intraoperative and postoperative 24-hourbloodloss, and intraoperative blood transfusion volume were (4.21±0.74) mGy, (752.31±153.66) mL, (135.47±20.37) mL, and(357.92 ± 32.40) mL, respectively, which were significantly lower than (15.63 ± 2.39) mGy, (1 026.47 ± 212.52) mL,(328.19±38.92) mL, and (950.30±85.61) mL of the control group; the differences were statistically significant (P<0.05).At 24 hours after surgery, the serum levels of Cor, ACTH, E, and NE in the study group were significantly lower thanthose in the control group, while APTT, TT, PT, FIB, Hb, and HCT were significantly higher than those in the controlgroup, with statistically significant differences (P<0.05). At 1 minute and 5 minutes after birth, the Apgar scores of new-borns in the study group were (9.02±0.27) points and (9.52±0.24) points, respectively, which were significantly higherthan (8.74±0.33) points and (9.13±0.30) points in the control group, and the neonatal asphyxia rate was 0, which was sig-nificantly lower than 19.35% in the control group, with statistically significant differences (P<0.05). The hysterectomyrate and complication rate in the study group were 6.45% and 6.45%, respectively, which were significantly lower than29.03% and 32.26% in the control group (P<0.05). Conclusion Prepositioned abdominal aorta balloon can reduce theradiation dose, blood loss, and blood transfusion during PPP accompanied with placenta implantation, reduce stress re-sponse, improve coagulation function, promote early postoperative recovery, improve surgical safety, improve neonataldelivery outcomes, and reduce the risk of asphyxia and hysterectomy.
      【Key words】 Dangerous placenta previa; Placental implantation; Prepositioned abdominal aorta balloon; Preposi-tioned internal iliac artery balloon; Stress response; Coagulation function; Newborns; Hysterectomy rate; Complication