子宫动脉栓塞治疗产后出血的预测因素分析
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摘要
目的:探讨影响子宫动脉栓塞治疗产后出血的疗效的因素。方法:回顾了武汉大学中南医院2010年1月至2016年12月对产后出血行子宫动脉栓塞治疗的62例病例的临床资料,行子宫动脉栓塞术治疗有效组49例,无效组13例,用多因素分析法比较了两组一般情况、孕产史、产科合并症以及其他因素对疗效的影响,提出可能导致子宫动脉栓塞治疗产后出血效果不佳的预测因素。结果:62例病例中,子宫动脉栓塞治疗产后出血无效者13例(21%)。不同于以往文献报道,发现胎盘因素(包括胎盘植入和胎盘粘连)是导致产后出血的主要因素。无效组中休克指数及DIC指数明显高于有效组。结论:胎盘粘连是我院产后大出血的主要原因,当产后出血量超过1 500mL预示着子宫动脉栓塞术治疗产后出血效果不佳。对于有持续出血的病人在生命体征稳定、出现血流动力学改变之前,子宫动脉栓塞可以被直接启用。
Objective: To identify the predictive factors of a poor response to uterine arterial embolization(UAE) for the treatment postpartum hemorrhage(PPH).Methods: This is a retrospective cohort study which included 62 cases of PPH treated by UAE in our hospital from January 2010 to September 2016. Medical and obstetric history, clinical elements and other biological parameters were compared in good-response group(49 cases) versus poor-response group(13 cases). Univariate analysis was performed to determine the factors related to poor response to UAE for treatment of PPH.Results: UAE failed in 13 cases(21. 0%). Our study showed that placental factors(including placenta accreta and placenta previa) were the most common causes for PPH. Shock index and total obstetrical DIC scores were higher in the poor-response group than in the good-response group.Conclusion: Placental factors are the main cause of postpartum hemorrhage in our hospital. When the postpartum hemorrhage exceeds 1 500 mL, it indicates failed PAE. Uterine artery embolization can be directly activated in patients with persistent bleeding before vital signs are stabilized and hemodynamic changes occur.
Objective: To identify the predictive factors of a poor response to uterine arterial embolization(UAE) for the treatment postpartum hemorrhage(PPH).Methods: This is a retrospective cohort study which included 62 cases of PPH treated by UAE in our hospital from January 2010 to September 2016. Medical and obstetric history, clinical elements and other biological parameters were compared in good-response group(49 cases) versus poor-response group(13 cases). Univariate analysis was performed to determine the factors related to poor response to UAE for treatment of PPH.Results: UAE failed in 13 cases(21. 0%). Our study showed that placental factors(including placenta accreta and placenta previa) were the most common causes for PPH. Shock index and total obstetrical DIC scores were higher in the poor-response group than in the good-response group.Conclusion: Placental factors are the main cause of postpartum hemorrhage in our hospital. When the postpartum hemorrhage exceeds 1 500 mL, it indicates failed PAE. Uterine artery embolization can be directly activated in patients with persistent bleeding before vital signs are stabilized and hemodynamic changes occur.
引文
[1]中华医学会妇产科学分会产科学组.产后出血预防与处理指南(2014)[J].中华妇产科杂志,2014,49(9):641-646.Obstetrics Group of the Chinese Society of Obstetrics and Gynecology. Guideline on the prophylaxis and treatment of postpartum haemorrhage 2014[J]. Chinese Journal of Obstetrics and Gynecology, 2014, 49(9):641-646.
[2] Aderoba AK, Olagbuji BN, Akintan AL, et al. Condom-catheter tamponade for the treatment of postpartum haemorrhage and factors associated with success:a prospective observational study[J]. BJOG, 2017, 124(11):1 764-1 771.
[3] Xu JQ. Effectiveness of embolization of the internal iliac or uterine arteries in the treatment of massive obstetrical and gynecological hemorrhages[J]. Eur Rev Med Pharmacol, 2015,19(3):372-374.
[4] Ganguli S, Stecker MS, Pyne D, et al. Uterine artery embolization in the treatment of postpartum uterine hemorrhage[J]. J Vasc Interv Radiol, 2011, 22:169-176.
[5] Gizzo S, Saccardi C, Patrelli T, et al. Fertility rate and subsequent pregnancy outcome after conservative surgical techniques in postpartum hemorrhage:15 years of literature[J]. Fertil Steril, 2013,99:2 097-2 107.
[6] Ballas J, Hull AD, Saenz C, et al. Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta:a management paradox[J]. Am J Obstet Gynecol, 2012,207(3):e1-e5.
[7] Sentilhes L, Gromez A, Clavier E, et al. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage[J]. Obstet Gynecol, 2009,113(5):992-999.
[8] Lal AK, Nyholm J, Wax J, et al. Resolution of complete placentaprevia:does prior cesarean delivery matter[J]? J Ultrasound Med, 2012,31(4):577-580.
[9] Cheong JY, Kong TW, Son JH, et al. Outcome of pelvic arterial embolization for postpartum hemorrhage:A retrospective review of 117 cases[J]. Obstet Gynecol,2014,57(1):17-27.
[10] Teixidor Vi?as M, Chandraharan E, Moneta MV, et al. The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta[J]. Clin Radiol,2014,69(8):e345-e351.
[2] Aderoba AK, Olagbuji BN, Akintan AL, et al. Condom-catheter tamponade for the treatment of postpartum haemorrhage and factors associated with success:a prospective observational study[J]. BJOG, 2017, 124(11):1 764-1 771.
[3] Xu JQ. Effectiveness of embolization of the internal iliac or uterine arteries in the treatment of massive obstetrical and gynecological hemorrhages[J]. Eur Rev Med Pharmacol, 2015,19(3):372-374.
[4] Ganguli S, Stecker MS, Pyne D, et al. Uterine artery embolization in the treatment of postpartum uterine hemorrhage[J]. J Vasc Interv Radiol, 2011, 22:169-176.
[5] Gizzo S, Saccardi C, Patrelli T, et al. Fertility rate and subsequent pregnancy outcome after conservative surgical techniques in postpartum hemorrhage:15 years of literature[J]. Fertil Steril, 2013,99:2 097-2 107.
[6] Ballas J, Hull AD, Saenz C, et al. Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta:a management paradox[J]. Am J Obstet Gynecol, 2012,207(3):e1-e5.
[7] Sentilhes L, Gromez A, Clavier E, et al. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage[J]. Obstet Gynecol, 2009,113(5):992-999.
[8] Lal AK, Nyholm J, Wax J, et al. Resolution of complete placentaprevia:does prior cesarean delivery matter[J]? J Ultrasound Med, 2012,31(4):577-580.
[9] Cheong JY, Kong TW, Son JH, et al. Outcome of pelvic arterial embolization for postpartum hemorrhage:A retrospective review of 117 cases[J]. Obstet Gynecol,2014,57(1):17-27.
[10] Teixidor Vi?as M, Chandraharan E, Moneta MV, et al. The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta[J]. Clin Radiol,2014,69(8):e345-e351.