| 摘要: |
| 目的 探讨基于超声征象和临床高危因素的风险模型预测凶险性前置胎盘患者术中严重出血风险的临床价值。方法 选取凶险性前置胎盘患者80例，根据术中出血量分为轻型出血组（出血量＜1000 ml）27例和重型出血组（出血量≥1000 ml）53例，比较两组间超声征象、临床高危因素的差异。采用二元Logistic回归分析筛选凶险性前置胎盘患者术中严重出血的独立危险因素，建立风险模型，绘制受试者工作特征（ROC）曲线分析其预测凶险性前置胎盘患者术中严重出血的诊断效能。结果 轻型出血组中，12例（44.4%）无PAS，13例（48.1%）粘连，2例（7.4%）植入；重型出血组中，11例（20.8%）粘连，24例（45.2%）植入，18例（34.0%）穿透。共7例行子宫切除，均为重型出血组。轻型出血组与重型出血组剖宫产次数、胎盘后间隙消失、胎盘陷窝、子宫膀胱交界面血流丰富、膀胱线中断、宫颈受累比较，差异均有统计学意义（均P＜0.05）。二元Logistic回归分析显示，剖宫产次数和子宫膀胱交界面血流均为术中严重出血的独立危险因素（OR=10.560、15.831，均P＜0.05）；由此建立的预测模型预测凶险性前置胎盘患者术中严重出血的ROC曲线下面积为0.787，均高于剖宫产次数、子宫膀胱交界面血流（分别为0.632、0.768）（P<0.05）。结论 基于剖宫产次数和子宫膀胱交界面血流的风险模型在预测凶险性前置胎盘患者术中严重出血中有良好的诊断效能。 |
| 关键词: 严重出血 胎盘植入性疾病 凶险性前置胎盘 子宫切除 |
| DOI： |
| 投稿时间：2024-02-21修订日期：2024-08-06 |
| 基金项目: |
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| The clinical value of a risk model based on ultrasound signs combined with clinical risk factors to predict the risk of severe bleeding during operation in dangerous placenta previa |
| Cui Jingjing,Xue Jingjing,Wangli,Ge Huiyu |
| () |
| Abstract: |
| Objective Clinical risk factors and ultrasound signs were used to predict the risk of severe intraoperative bleeding in dangerous placenta previa，and a risk model was established.Methods 80 patients with dangerous placenta previa admitted to Beijing Chaoyang Hospital and Beijing Obstretrics and Gynecology Hospital of Capital Medical University from August 2018 to December 2023 were retrospectively analyzed.The amount of intraoperative bleeding ＜ 1000ml was defined as light bleeding.If the amount of intraoperative bleeding is ≥1000ml，it is severe bleeding.The clinical risk factors and ultrasound signs were compared between the two groups.A risk model of severe intraoperative bleeding in patients with dangerous placenta previa was established based on clinical risk factors and ultrasound signs.Results In 80 cases，27 cases were in moderate and 53 cases in severe group.In the mild group，12 cases（44.4%） had no PAS，13 cases（48.1%） had accreta，and 2 cases（7.4%） had increta.In the severe group，11 cases（20.8%） accreta，24 cases（45.2%） increta，and 18 cases（34.0%） percreta.A total of 7 patients underwent hysterectomy，all of whom were in the severe group.There were significant differences in the number of cesarean section，disappearance of retroplacental space，placental lacunae，abundant blood flow at uterovesical junction，interruption of bladder line and cervical involvement between the two groups（p<0.05）.Binary Logistic regression analysis showed that the number of cesarean section and abundant blood flow at the uterovesical junction were independent risk factors for severe intraoperative bleeding(OR=10.560、15.831,P<0.05).Based on this，a risk model was established and the ROC curve of each independent risk factor and risk model was drawn.The AUC of the risk model was 0.787，which had better diagnostic performance than other independent risk factors（0.632、0.768，respectively）.Conclusion In the evaluation of severe intraoperative bleeding in patients with dangerous placenta previa，the number of cesarean section and abundant flow at the uterovesical junction were combined to establish a hemorrhage risk model，which has good diagnostic efficacy for severe hemorrhage. |
| Key words: severe bleeding placenta accreta spectrum disorders dangerous placenta previa hysterectomy |
