血管钳夹在伴有胎盘增生的剖宫产中的应用:病例报告及文献复习

IF 0.2 Q4 ANESTHESIOLOGY
Sandipika Dogra, Kameswari Surampadi, Manokanth Madapu, S. Pandya
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引用次数: 0

摘要

剖腹产(CS)发生率的增加增加了妊娠期胎盘植入谱(PAS)疾病的风险。主动脉血管夹可用于低资源环境,以最大限度地减少PAS产妇的产科大出血。我们报告了一例可归因于PAS的产科大出血和其他可能在自然循环恢复后出血的病例。第一例患者在接受percreta的经典CS治疗后出现大出血,导致严重的血液动力学不稳定,尽管采用了标准的方案治疗,但仍接近停搏。作为控制灾难性出血的最后手段,主动脉血管夹被用来避免即将到来的心脏骤停,这成功地导致了有效的复苏和后来的平静恢复。第二个病例是一例经诊断的percreta胎盘的剖宫产,我们打算在复苏性子宫切开术[剖宫产(PMCD)]中使用这种夹子,因为它的使用可能会在ROSC出血后提供血液动力学稳定性。然而,病人无法苏醒。我们发现,除了应对产科大出血的麻醉和大出血管理技能外,提供训练有素的手术团队来控制持续出血对有效复苏至关重要。使用主动脉和髂总血管夹作为损伤控制措施,在控制灾难性孕产妇出血方面也发挥着非常重要的作用。随着PAS发生率的增加和这些产妇出血失控,如果出血得不到控制,麻醉师熟练的麻醉和复苏技能是徒劳的。我们发现,PMCD时血管夹的可用性和使用对控制出血和帮助有效复苏非常有用。它的使用具有短的学习曲线,并且人员可以容易地进行培训。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Vascular clamps in perimortem caesarean delivery in parturients with placenta accreta spectrum: Case report and literature review
The increasing incidence of caesarean section (CS) increases the risk for placenta accrete spectrum (PAS) conditions in pregnancy. The aortic vascular clamps can be used in low resource settings to minimise major obstetric haemorrhage in a parturient with PAS. We report one case of major obstetric haemorrhage attributable to PAS and other cases that had the potential to bleed post-return of spontaneous circulation (ROSC). The first case had torrential bleed following classical CS done for percreta leading to severe haemodynamic instability and a near arrest situation despite standard protocolised management. As a last resort to control catastrophic bleeding, the aortic vascular clamp was used to avert an imminent cardiac arrest, which successfully lead to effective resuscitation and later uneventful recovery. The second case was a perimortem caesarean delivery in a diagnosed case of placenta percreta where we contemplated to use this clamp during resuscitative hysterotomy [Perimortem caesarean delivery (PMCD)] as its usage is likely to confer haemodynamic stability post-ROSC bleeding. However, the patient could not be revived. We have found that in addition to anaesthetic and major haemorrhage management skills in tackling a massive obstetric haemorrhage, the availability of trained surgical teams for controlling ongoing haemorrhage is crucial for effective resuscitation. Using aortic and common iliac vascular clamps as a damage control measure also plays a very important role in controlling catastrophic maternal haemorrhage. With the growing incidence of PAS and uncontrolled bleeding in these parturients, the skilled anaesthetic and resuscitative skills of anaesthesiologists are futile if haemorrhage is not controlled. We found that the availability and use of the vascular clamps at the time of PMCD are very useful to control bleeding and help in effective resuscitation. Its use has a short learning curve and the personnel can be trained easily.
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