41例胎盤早剝診斷與母嬰結局分析

楊愛娟 吳佳嘉

[摘要] 目的 回顧胎盤早剝的臨床資料，分析早期識別胎盤早剝的臨床線索及處理要點，達到改善母嬰結局，降低母兒并發癥發生率的目的。方法 回顧性分析該院2015年1月—2018年12月收治的41例胎盤早剝患者，根據胎盤早剝病情的實際嚴重情況分為0級（n=19）、I級（n=2）、II級（n=5）、III級（n=15）。分析發病原因、臨床表現、分辨方式及產婦結局及圍產兒結局。結果 41例胎盤早剝患者中32例存在明確誘因，其中比例最高的分別是妊娠期高血壓疾病、胎膜早破，其次是外傷、臍帶因素，腰腹脹痛、陰道流血、胎心異常是該組胎盤早剝的主要特征，合并2種以上的Ⅱ級和Ⅲ級胎盤早剝組占43.9%，0級胎盤早剝為0.0%，0級與Ⅱ、Ⅲ級胎盤早剝臨床特征差異有統計學意義（P<0.05）。結論 妊娠期高血壓疾病、胎膜早破是胎盤早剝的主要發病原因，其次有外傷、臍帶因素等。加強對醫療技術相對落后的偏遠山區孕婦孕期監測，及時發現胎盤早剝，組建搶救團隊并有效治療，對合并難治性產后出血的患者果斷切除子宮，能降低母兒死亡率，提高治療效果，改善母嬰結局。

[關鍵詞] 胎盤早剝;妊娠期高血壓疾病;母嬰結局

[中圖分類號] R5 ? ? ? ? ?[文獻標識碼] A ? ? ? ? ?[文章編號] 1674-0742（2019）10（c）-0083-04

[Abstract] Objective To review the clinical data of placental abruption and analyze the clinical clues and treatment points of early detection of placental abruption， to improve the outcome of maternal and child outcomes and reduce the incidence of maternal and child complications. Methods A retrospective analysis of 41 patients with placental abruption who were admitted to the hospital from January 2015 to December 2018 was divided into level 0 （n=19） and level I （n=2）， level II （n=5）， level III （n=15） according to the actual severity of placental abruption. Analysis of the cause of the disease and clinical manifestations， resolution and maternal outcomes and perinatal outcomes. Results Among the 41 patients with placental abruption， 32 patients had clear incentives. The highest proportions were hypertensive disorders of pregnancy and premature rupture of membranes， followed by trauma， umbilical cord factors， waist and abdomen swelling/pain， vaginal bleeding， and abnormal fetal heart rate. The main features of this group of placental abruption， combined with more than 2 kinds of level II and III placental abruption group accounted for 43.9%， grade 0 placental abruption was 0.0%， and the difference of 0 grade and II， III grade placental abruption clinical characteristics were statistically significant （P<0.05）. Conclusion Hypertensive disorder of pregnancy and premature rupture of membranes are the main causes of placental abruption， followed by trauma and umbilical cord factors. Strengthen the monitoring of pregnant women in remote mountainous areas with relatively backward medical technology， timely discover the placental abruption， set up a rescue team， effectively treat， and decisively remove the uterus with refractory postpartum hemorrhage， which can reduce the maternal and child mortality， improve the treatment effect， and improve maternal and child outcomes.