改良式TACS术对剖宫产PPH患者子宫动脉血流动力学及凝血、卵巢功能的改善效应研究OA

Objective To explore characteristics of changes in uterine artery hemodynamics,coagulation and ovarian functions of patients with postpartum hemorrhage(PPH)after cesarean section treated with modified transverse annular compression sutures(TACS)of the lower uterine segment.Methods A total of 122 patients with PPH who admitted to Jiangyin People's Hospital from June 2021 to May 2023 were selected as study subjects.According to treatment method,they were divided into study group(64 patients received TACS operation)and control group(58 patients received"8-shape"suture combined with intrauterine balloon compression for hemostasis).Propensity score matching(PSM)method was used to match pairs of patients in 1∶1 ratio,and a total of 100 patients were successfully matched,50 patients in each group.The hemodynamic parameters of uterine arteries,coagulation function indexes and ovarian function indexes of the patients before surgery,at 24 hours after surgery and at 48 hours after surgery were compared between the two groups.Repeated measures analysis of variance(ANOVA)method was used to analyze and compare dynamic changes in hemodynamic parameters of uterine arteries of the patients between the two groups.Log-binomial regression was used to calculate relative risk(RR)of complication incidence in the two groups.Results Compared with hemodynamic parameters before operation,resistance index(RI),uterine artery pulsatility index(PI),and ratio of maximum systolic blood flow velocity to maximum diastolic blood flow velocity(S/D)of the PPH patients in both groups decreased after operation,while average blood flow velocity(mean velocity,Vm)significantly increased(F values ranged from 14.159 to 69.831,all P<0.05).At 48 hours after operation,PI,RI,S/D of the PPH patients in the study group were all lower than those in the control group,while Vm was higher than that in the control group(t=2.622-9.055,all P<0.05).Prothrombin time(PT),activated partial thromboplastin time(APTT)of the PPH patients in the two groups after operation,and estradiol(E2)level of the PPH patients in the study group after operation were lower than those before operation,while fibrinogen(FIB),luteinizing hormone(LH),and follicle-stimulating hormone(FSH)levels were higher than those before operation(F=2.416-39.812,all P<0.05).After operation,the levels of PT,APTT and E2 in the study group were significantly lower than those in the control group,while the levels of FIB,LH and FSH were significantly higher than those in the control group(t=2.660-14.652,all P<0.05).The total effective rate in the study group was significantly higher than that in the control group(χ2=5.005,P<0.05).The total risk of complications in the study group was significantly decreased(RR<1,P<0.05).Conclusion Modified TACS can significantly improve hemodynamics of uterine artery,coagulation function and ovarian function of the patients with PPH,and improve clinical efficacy for treatment of PPH.