Application of cesarean section with preserved fetal membrane sac in premature delivery of twin-pregnant women
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摘要:目的
探讨保留胎膜囊剖宫产术在早产双胎妊娠中的应用价值。
方法回顾性分析2019—2021年在苏北人民医院因早产行保留胎膜囊剖宫产术分娩的20例双胎孕妇(观察组)的临床资料, 另选取同期收治的30例早产行常规新式子宫下段剖宫产术分娩的双胎孕妇为对照组。分析不同术式在手术时间、羊水量、术中出血量、新生儿Apgar评分、新生儿出生体质量、新生儿窒息等方面的差异; 比较保留胎膜囊剖宫产术与常规新式子宫下段剖宫产术在手术指标及妊娠结局方面的差异。
结果观察组手术时间为(37.63±10.85)min, 短于对照组的(50.00±10.50)min, 差异有统计学意义(P < 0.05);观察组术中出血量为(384.21±229.16)mL, 多于对照组的(373.33±163.86)mL, 但差异无统计学意义(P>0.05)。完全保留胎膜囊娩出的新生儿平均肌酸激酶水平为(247.50±85.19)U/dL, 低于对照组的(311.35±138.03)U/dL, 差异有统计学意义(P < 0.05)。保留胎膜囊剖宫产术与常规新式子宫下段剖宫产术在术中出血量及新生儿窒息方面比较，差异无统计学意义(P>0.05)。
结论保留胎膜囊剖宫产术能缩短手术时间，有利于改善早产双胎妊娠的结局，可能对减轻早产儿心肌损伤有积极的作用。
Abstract:ObjectiveTo explore application value of cesarean section with preserved fetal membrane sac in premature delivery of twin-pregnant women.
MethodsThe clinical data of 20 twin-pregnant women who performed cesarean section with preserved fetal membrane sac due to premature delivery in North Jiangsu People's Hospital from 2019 to 2021 were retrospectively analyzed. Another 30 twin-pregnant women who performed conventional lower uterine section for delivery in twin-pregnant women in the same period were selected as control group. The differences of operation time, amniotic fluid volume, intraoperative blood loss, neonatal Apgar score, neonatal birth weight, neonatal asphyxia and other aspects were analyzed. The differences of surgical indicators and pregnancy outcomes between cesarean section with preserved fetal membrane sac and conventional new lower uterine were compared.
ResultsThe average operation time of the observation group was (37.63±10.85) min, which was significantly shorter than (50.00±10.50) min in the control group(P < 0.05). The intraoperative blood loss in the observation group was (384.21±229.16) mL, which was more than (373.33±163.86) mL in the control group, but no significant difference was observed (P>0.05). The mean creatine kinase level in neonates with completely preserved fetal sac was (247.50±85.19) U/dL, which was lower than (311.35±138.03) U/dL in the control group and the difference was statistically significant (P < 0.05). There were no significant differences in intraoperative blood loss and neonatal asphyxia between cesarean section with preserved fetal membrane sac and conventional new lower uterine section (P>0.05).
ConclusionCesarean section with preserved fetal membrane sac can shorten operation time, improve the outcome of premature twin pregnancy, and may have a positive effect in reducing myocardial injury in premature infants.
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表 1 观察组10例采取保留与未保留胎膜囊孕妇所娩新生儿的相关指标比较(x±s)
指标 未保留组(n=10) 单一保留组(n=10) 羊水量/mL 430.00±48.30 410.00±31.63 出生体质量/g 2 458.00±325.92 2 446.00±377.34 新生儿血pH值 7.33±0.03 7.34±0.05 新生儿动脉血二氧化碳分压/mmHg 28.97±9.29 27.77±7.39 新生儿动脉血氧分压/mmHg 87.00±26.03 83.34±21.66 新生儿血乳酸/(mmol/L) 2.03±0.75 1.69±0.37 新生儿血碱剩余/(mmol/L) -9.68±2.87 -9.50±3.16 新生儿血肌酸激酶/(U/dL) 288.14±223.40 339.00±96.94 新生儿血肌酸激酶同工酶/(U/dL) 72.71±44.62 98.30±76.94 n表示所娩新生儿的例数。 
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表 2 完全保留组、所有保留组及对照组新生儿相关指标比较(x±s)
指标 完全保留组(n=20) 所有保留组(n=30) 对照组(n=60) 羊水量/mL 430.00±47.02 423.33±43.02 415.00±56.97 出生体质量/g 2 357.00±303.42 2 386.67±326.08 2 366.17±382.28 新生儿血pH值 7.30±0.06 7.31±0.06 7.33±0.05 新生儿动脉血二氧化碳分压/mmHg 30.25±10.31 29.08±9.40 27.83±10.76 新生儿动脉血氧分压/mmHg 92.98±22.43 90.01±22.23 95.85±22.95 新生儿血乳酸/(mmol/L) 1.72±0.37 1.71±0.36 1.82±0.65 新生儿血碱剩余/(mmol/L) -10.93±2.85 -10.50±2.96 -9.65±4.68 新生儿血肌酸激酶/(U/dL) 247.50±85.19* 273.12±96.17 311.35±138.03 新生儿血肌酸激酶同工酶/(U/dL) 65.83±34.93 75.82±52.16 86.03±51.93 n表示娩出新生儿的例数。与对照组比较, *P < 0.05。
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