子宫瘢痕妊娠的临床护理

子宫瘢痕妊娠的临床护理

目的探讨剖宫产术后子宫瘢痕妊娠（CSP）的不同病情观察及药物治疗和手术治疗的护理要点。方法收集本院2009年10月~2011年2月收治的18例CSP病例，其中2例因误诊早孕、刮宫后出血不止急行宫腔镜检查+妊娠病灶清除术；4例行双侧子宫动脉栓塞术；12例行米非司酮、米索前列醇加肌注甲氨蝶

呤药物治疗。结果18例患者无一例因大出血而行子宫切除术,均保留了生育

功能。结论根据CSP病情及不同处理方法,制定针对性的护理对策,精心护理,密切观察病情,及时发现异常情况对症处理,可有效预防和减少剖宫产瘢痕妊娠的并

发症,减少子宫切除率,提高剖宫产瘢痕妊娠患者的生活质量。

标签：瘢痕妊娠；药物流产；动脉栓塞术；护理

Nursing of cesarean scars pregnancy LI Yingying，GON Guifang，XIE Xia.Guangzhou Women and Children s Medical Center,Guangzhou 510623，China

【Abstract】Objective To investigate the key points of nursing on the observation of different patient s condition and drug therapy and surgical therapy for cesarean scars pregnancy(CSP).Methods To collect the information of 18 patients with CSP who were received and cured in our hospital,among them,2 patients received the emergency hysteroscopy and pregnancy focus clearance because of the bleeding after curettage which was related to the misdiagnosis of early pregnancy.4 patients received bilateral uterine arterial embolization.12 patients received the drug treatment by using Misfepristone,Misoprostol,and intramuscular injection of methotrexate.Results None of 18 patients received hysterectomy casued by massive haemorrhage,they all retained reproductive function.Conclusion Working out the

pertinent nursing plan according to the patient s condition and different treatments,taking intensive care of them,and observing the patient s condition carefully,to find out patient s abnormalities timely and take the measure symptomatically.all the above measures could prevent the complication of CSP from happening,reduce the rate of hysterectomy ,and improve the patient s life quality.

【Key words】Cesarean scars pregnancy；Pharmaceutical abortion；Arterial embolization；Nursing

子宫瘢痕部位妊娠(CSP)是指胚胎着床于剖宫产后瘢痕处的微小缝隙上,为罕见的异位妊娠类型,发生率约为0.45‰,占异位妊娠的6.1%。因临床表现缺乏特异性,发病早期不易发现,继续妊娠或人流刮宫可能发生致命大出血、子宫穿孔,

甚至休克,严重时需行子宫切除术［1］。现将笔者所在医院自2009年10

月~2011年2月诊治的18例CSP病例报告如下,以提高临床对该病的诊疗及护理

水平。

1 资料与方法

1.1 一般资料18例患者均为育龄期妇女,年龄22~41岁，平均(31±6) 岁，孕2~4次，均有1次以上剖宫产史，剖宫产方式均为子宫下段横切口,剖宫产距本次妊娠时间为6个月~13年。18例均有停经史,停经时间为38~71 d，血、尿妊娠试验阳性。12例主诉为停经后不规则阴道流血,阴道流血时间2~30 d, 其中9例因早孕行B超检查提示子宫增大,孕囊位于子宫下段剖宫产切口部位疤痕处,见胚芽,胚囊周围血流丰富；3例见心血管搏动，而考虑剖宫产瘢痕处妊娠；6例曾在明确诊断前于外院行一次以上药物流产、清宫术或人流术,因术中阴道出血多或术

后阴道流血淋漓不尽而转至本院诊治。

1.2 治疗及结果2例因停经在笔者所在医院门诊查尿hCG阳性,行B超检查后，诊断为早孕。行清宫术后阴道流血不止,收入院。入院后予以加强宫缩治疗及纱布压迫止血均未见好转,急行宫腔镜检查+清宫术，术后恢复好,出院后定期门诊随访。12例用米非司酮配伍米索前列醇口服后局部注射甲氨蝶呤。在治疗过

程中严密监测阴道出血以及血β-hCG水平下降情况,并定期复查超声。经药

物治疗在hCG下降后,B超监测下行清宫术。以上病例均在清宫术后血β-hCG水

平明显下降或阴道出血停止后出院,住院时间为10~21 d。

4例行双侧子宫动脉栓塞术,栓塞术后24 h内在超声引导下行清宫术。1例在清宫过程中出现阴道流血多而改为经腹病灶清除+子宫修补术。