米非司酮辅助Bakri球囊填塞术在凶险性前置胎盘中的应用及预后影响

目的 探讨米非司酮辅助Bakri球囊填塞术在凶险性前置胎盘中的应用效果及对母婴预后的影响.方法 选取2015年1月至2016年8月于北京市海淀区妇幼保健院进行分娩的78例凶险性前置胎盘产妇作为研究对象,所有产妇均接受剖宫产术.回顾性分析其临床资料,根据治疗方案分为对照组32例和观察组46例.常规治疗基础上,对照组产妇给予Bakri球囊填塞术,观察组产妇在对照组基础上给予米非司酮辅助治疗.比较两组止血效果、产妇预后及新生儿预后.结果 与对照组相比,观察组产妇术中出血量、术后2h阴道出血量、术后2～24h阴道出血量明显减少(t值分别为7.702、6.991、8.718,均P＜0.05),产后出血率明显降低(x2 =3.897,P＜0.05).与对照组相比,观察组产妇弥漫性血管内凝血(DIC)发生率、产褥病率显著降低(x2值分别为4.482、4.088,均P＜0.05),而子宫切除率组间比较无统计学差异(x2=0.747,P＞0.05).与对照组相比,观察组新生儿Apgar评分显著升高(t=2.208,P＜ 0.05),而呼吸窘迫、新生儿窒息发生率组间比较无统计学差异(x2值分别0.803、0.796,均P＞0.05).结论 米非司酮辅助Bakri球囊填塞术在凶险性前置胎盘中应用效果良好,能够显著减少出血量,改善母婴预后,临床上值得应用推广.

Application and prognostic influence of mifepristone assisting Bakri balloon packing in pernicious placenta previa

Objective To investigate the effect of mifepristone assisting Bakri balloon packing in treatment of pernicious placenta prewa and its influence on maternal and neonatal prognosis.Methods Totally 78 cases with pernicious placenta previa deliverying in Haidian Maternal and Child Health Hospital of Beijing during January 2015 to August 2016 were selected as research objects.All of them received cesarean section.The clinical data of the patients were retrospectively analyzed.According to therapeutic schemes,they were divided into control group (n =32) and observation group (n =46).Besides conventional treatments,the control group was treated with Bakri balloon packing,while the observation group was treated with mifepristone assisting Bakri balloon packing.The hemostatic effect,maternal prognosis and neonatal prognosis were compared between two groups.Results Compared with the control group,the intraoperative bleeding volume,postoperative vaginal bleeding volume at 2h and during 2-24h of patients in the observation group were significantly less (t value was 7.702,6.991 and 8.718,respectively,all P ＜ 0.05),and the incidence of postpartum hemorrhage of patients in the observation group was significantly lower than that in the control group (x2 =3.897,P ＜ 0.05).The incidence of DIC and puerperal disease of patients in the observation group were significantly lower than those in the control group (x2 value was 4.482 and 4.088,respectively,both P ＜ 0.05),but there was no statistical difference in hysterectomy rate between two groups (x2 =0.747,P ＞ 0.05).The neonatal Apgar score in the observation group was significantly higher than that in the control group (t =2.208,P ＜ 0.05).There was no significant difference in the incidence of respiratory distress and neonatal asphyxia between two groups (x2 value was 0.803 and 0.796,respectively,both P ＞ 0.05).Conclusion Mifepristone assisting Bakri balloon packing is effective in the treatment of pernicious placenta previa.It can significantly reduce the amount of bleeding and improve maternal and neonatal prognosis,which is worthy of clinical application.