Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, China.
Anaesthesia. 2017 Jul;72(7):853-858. doi: 10.1111/anae.13895. Epub 2017 Apr 12.
We performed an impact study on the introduction of routine placement of internal iliac artery balloon catheters for the management of haemorrhage during caesarean section in women with placenta accreta. We identified 11 women, with prenatally diagnosed placenta accreta/increta/percreta before this change in practice, who acted as controls, and 30 women who had iliac artery balloons placed. The balloons were inflated in 27 cases. The median (IQR [range]) intra-operative blood loss was 1100 (800-2600 [500-6000]) ml in controls, compared with 1000 (600-2513 [400-15000]) ml in women with iliac artery balloons (p = 0.64). Six (54%) controls received intra-operative blood transfusion compared with 14 (47%) women with iliac artery balloons (p = 0.66). Caesarean hysterectomy was performed in 3 (27.3%) controls and 13 (43.3%) women with iliac artery balloons (p = 0.48). Balloon catheter insertion was associated with a shortened postoperative hospital stay, 6 (5-7 [4-12] days in controls vs. 5 (4-6 [3-10]) in the iliac artery balloon group (p = 0.033). General anaesthesia was used in six (54%) controls, but all women with iliac artery balloons. This study demonstrates that prophylactic balloon occlusion of the internal iliac arteries did not reduce intra-operative haemorrhage or caesarean hysterectomy in women with placenta accreta undergoing caesarean section. In addition, it has a significant impact on the choice of anaesthetic technique.
我们对常规放置髂内动脉球囊导管以管理前置胎盘剖宫产术中出血的方法进行了影响研究。在实践改变之前，我们确定了 11 名产前诊断为胎盘植入/增生/穿透的女性作为对照组，有 30 名女性放置了髂内动脉球囊。在 27 例中充气了球囊。对照组术中失血量中位数（IQR[范围]）为 1100（800-2600[500-6000]）ml，而放置髂内动脉球囊的女性为 1000（600-2513[400-15000]）ml（p=0.64）。6 名（54%）对照组接受术中输血，而放置髂内动脉球囊的 14 名（47%）女性接受输血（p=0.66）。3 名（27.3%）对照组和 13 名（43.3%）放置髂内动脉球囊的女性行剖宫产子宫切除术（p=0.48）。球囊导管插入术与术后住院时间缩短相关，对照组为 6（5-7[4-12]天），而髂内动脉球囊组为 5（4-6[3-10]）天（p=0.033）。对照组中有 6 名（54%）使用全身麻醉，但所有放置髂内动脉球囊的女性均使用全身麻醉。本研究表明，预防性阻断髂内动脉并不能减少前置胎盘剖宫产术中的术中出血或剖宫产子宫切除术。此外，它对麻醉技术的选择有重大影响。
