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目的通过分析行产时胎儿手术的母体预后,探讨产时胎儿手术的可行性、安全性及预防产后出血,保证母体良好预后的有效措施。方法回顾性分析2008年8月至2009年10月我院成功施行产时胎儿手术的10例患者[产时胎儿手术组(IFO组),n=10]术中及术后24h内出血量,术前和术后24h的血红蛋白水平、宫缩情况、产褥感染的发生情况,产后42d随访情况并与同期因拒绝试产行择期剖宫产手术的10例健康孕妇(对照组)进行各项指标比较。结果两组患者的子宫复旧情况均正常,均无早期及晚期产后出血及产褥感染发生。IFO组母体术中出血量、术后24h及术中+术后24h总出血量、术前和术后及产后42d复查的血红蛋白浓度与对照组相比均无统计学差异(P>0.05)。IFO组剖宫产术时间为(66.40±53.40)min,与对照组(34.50±4.97)min相比未见统计学差异(P<0.05)。术中出血量、术后24h内产后出血量及术中+术后24h出血量均与患者的年龄和孕周无相关(P>0.05),而与剖宫产术时间呈正相关(r=0.458,P=0.021),其线性回归方程为:Y(ml)=172.68+1.342X。结论产时胎儿手术对于母体的子宫复旧无明显影响,不增加产后出血量及产褥感染发生率,对母体是安全的。采用积极有效的预防措施可以使产时手术的孕产妇的产后出血量并不明显超过普通剖宫产术,积极提高胎儿手术技术,尽量缩短产时手术时间也是预防母体产后出血的一项重要措施。
Objective To analyze the maternal prognosis of fetus surgery during delivery and to explore the feasibility and safety of labor during fetus during labor and to prevent postpartum hemorrhage so as to ensure a good prognosis for maternal. Methods A retrospective analysis was performed on 10 patients with successful fetus during labor from August 2008 to October 2009 in our hospital (intrauterine fetal operation group (IFO group), n = 10] and intraoperative and intraoperative bleeding amount within 24h Hemoglobin levels, uterine contractions and puerperal infection were observed before and 24 h after operation. The follow-up at postnatal 42 days was compared with 10 healthy pregnant women (control group) who refused to give birth during the same period of elective cesarean delivery Compare Results The two groups of patients with uterine involution are normal, no early and late postpartum hemorrhage and puerperal infection occurred. There was no significant difference between the two groups in the amount of hemorrhage, the amount of blood loss at 24 hours after operation, the total amount of blood loss at 24 hours after operation, and the level of hemoglobin in the IFO group compared with the control group (P> 0.05). The time of cesarean section in IFO group was (66.40 ± 53.40) min, which was not significantly different from that in control group (34.50 ± 4.97) min (P <0.05). The intraoperative blood loss, postpartum hemorrhage volume within 24 hours after operation, and intraoperative and postoperative 24h hemorrhage were all not related to the age and gestational age (P> 0.05), but positively correlated with the time of cesarean section (r = 0.458 , P = 0.021), the linear regression equation is: Y (ml) = 172.68 + 1.342X. Conclusion During labor, fetus operation has no significant effect on maternal uterine involution and does not increase the amount of postpartum hemorrhage and the incidence of puerperal infection, which is safe for the mother. The use of positive and effective preventive measures can make maternal postpartum hemorrhage during labor during labor hours do not significantly exceed that of ordinary cesarean delivery and actively improve fetal operation techniques to minimize labor hours as well as an important measure to prevent maternal postpartum hemorrhage .