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三级医疗中心宫腔内球囊填塞术后的高级介入性操作。

Advanced Interventional Procedures after Intrauterine Tamponade Balloon Insertion in a Tertiary Care Center.

机构信息

Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France.

Obstetrics and Gynecology Service, Bichat Teaching Hospital, Paris and Paris Diderot University, Paris, France.

出版信息

J Invest Surg. 2021 Apr;34(4):373-379. doi: 10.1080/08941939.2019.1637976. Epub 2019 Jul 19.

DOI:10.1080/08941939.2019.1637976
PMID:31322016
Abstract

To evaluate the rate of success and practicability of the intrauterine tamponade balloon (ITB) for managing PPH as a fertility-sparing tool. a five-year retrospective monocentric study in a tertiary care center including patients transferred for severe PPH. In 231 patients, the success rate of ITB ( = 57), embolization ( = 58), and medical management ( = 114) was 84.21%, 74.13%, and 76.32%, respectively. Cesarean section during labor did not influence the risk of advanced interventional procedures (AIPs) for patients with ITB (odds ratio [OR] = 1.08) but did so in patients who were under expectant management in the intensive care (OR = 5.29). In the AIP subgroup of the ITB group, hemostasis was significantly deteriorated. Prothrombin time <50% (OR = 11.5), fibrinogen <2 g/L (OR = 6.88), and >4 red blood cells units (RBCs) transfused (OR = 17.2) were associated with a significantly higher risk of failure. Blood loss in the AIP patients in the embolization group was significantly higher. Patients requiring >4 units of RBCs were 22.9 times more likely to have an AIP ( = .0001). Compared with uterine embolization and medical management, ITB use in a tertiary care center was associated with lower risk of undergoing AIP, but further prospective study is required to confirm this.

摘要

为评估宫腔内填塞球囊(ITB)作为一种保留生育能力的工具治疗产后出血(PPH)的成功率和实用性,对一家三级保健中心进行了一项为期五年的回顾性单中心研究,纳入了因严重 PPH 而转来的患者。在 231 例患者中,ITB( = 57)、栓塞( = 58)和药物治疗( = 114)的成功率分别为 84.21%、74.13%和 76.32%。分娩时行剖宫产并不会增加 ITB 患者行高级介入治疗(AIPs)的风险(比值比 [OR] = 1.08),但会增加在重症监护室接受期待治疗的患者的风险(OR = 5.29)。在 ITB 组的 AIP 亚组中,止血效果明显恶化。凝血酶原时间 <50%(OR = 11.5)、纤维蛋白原 <2 g/L(OR = 6.88)和输注 >4 个单位的红细胞(OR = 17.2)与失败风险显著增加相关。栓塞组 AIP 患者的出血量明显更高。需要输注 >4 个单位红细胞的患者发生 AIP 的可能性高 22.9 倍( = .0001)。与子宫动脉栓塞和药物治疗相比,在三级保健中心使用 ITB 与行 AIP 的风险较低相关,但需要进一步的前瞻性研究来证实这一点。

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