Transcatheter Arterial Embolization for Treating Intractable Post-Partum Hemorrhage: Early Success Indicators

經導管動脈栓塞術用於產後大出血控制之早期成功預測因子

阮昱翔(Yu-Hsiang Juan) ； 黃耀祥(Yon-Cheong Wong) ； 王俐人(Li-Jen Wang) ； 吳政賢(Cheng-Hsien Wu) ； 王超然(Chao-Jan Wang)

《中華放射線醫學雜誌》 34卷4期 (2009/12) Pp. 253-261

摘要

經導管動脈栓塞術對於治療產後大出血常常是有效的。但因為目前仍缺乏有效的早期成功預測因子，栓塞術失敗後的後續治療也因而常常被延誤。故本研究的目的在於找尋栓塞術後的早期成功預測因子。
本篇回溯性收集在2003年12月到2006年7月間，因無法控制之產後大出血而在本院接受經導管動脈栓塞術之20例病例；並根據栓塞治療後的結果將病患分為治療成功與治療失敗這兩組。栓塞治療成功的定義是病患接受栓塞治療後存活且不需要接受其他的介入性治療或手術。我們將治療後的結果與病患的基本資料，臨床表現，出血到栓塞時間，血管攝影檢查結果，生命徵象以及血液學檢查等因子做了分析。同時，我們也分析了治療成功與失敗的這兩組病患在栓塞前後的生命徵象以及血液學檢查上的差異。
在這20位病患中，有17位病患(85%)栓塞治療成功。分析後，病患的年齡大小，臨床特徵，出血到栓塞時間以及血管攝影檢查結果等因子皆與栓塞成功與否沒有顯著的關聯性。栓塞成功組裡的17位病患中有16位在栓塞後的收縮壓大於或等於90mmHg，而相較之下，栓塞失敗組裡面的3位病患中卻只有1位。故這兩組之間在栓塞後的收縮壓有著顯著性差異(p=0.007)。進一步分析栓塞成功組裡面的病患，他們在栓塞前後的體溫有顯著性的上升(p=0.036)，心率也有顯著性的下降(p=0.008)。
經導管動脈栓塞術對於產後大出血的治療常常是有效的。然而，栓塞術後若收縮壓仍小於90mmHg，體溫仍舊偏低，或心跳速率依然很快，此時就應儘快評估以減少持續出血及避免延誤後續的介入性治療或是手術。

並列摘要

Transcatheter arterial embolization (TAE) is an effective alternative treatment for intractable postpartum hemorrhage (PPH). However, when initial TAE failed, further treatment was often delayed because there were no early indicators for TAE success. This study aimed to identify early indicators of the outcome of TAE for PPH.
From December 2003 to July 2006, 20 consecutive patients underwent TAE for uncontrollable PPH in our hospital. TAE outcomes were categorised into success and failure groups. Success was defined as a patient survived PPH after TAE without requiring further any intervention or surgical procedure. We analyzed the association of successful TAE outcome with demographic features, clinical characteristics, TAE response time, angiographic findings, vital signs and hemogram. The changes in vital signs and hemograms in each outcome group (success or failure) before and after TAE were also analyzed.
Seventeen (85%) patient s had successful outcomes after TAE. Age, clinical characteristics, TAE response time and angiographic findings had no significant difference between the success and failure groups. There was a significant difference of post-TAE systolic blood pressure of greater than or equal to 90mmHg between success and failure groups (16 of 17 versus 1 of 3, respectively, p=0.007). The differences of body temperature (p=0.036) and heart rate (p=0.008) before and after TAE were also significantly different between both groups.
TAE is usually effective for treating PPH. Patients who had a systolic blood pressure less than 90 mmHg, low body temperature or rapid heart rate after TAE should be evaluated for the need of further intervention or surgery as soon as possible to stop the ongoing blood loss and avoid associated morbidity and mortality.