Evaluation Of The Application Of Tranexamic Acid In The Cesarean Section Of Pernicious Placenta Previa

ObjectivePernicious placenta previa(PPP)is placenta previa with a previous history of cesarean section,and placenta is attached to the scar site of the original uterus,often accompanied by placenta implantation.The disease is extremely dangerous,and it has the characteristics of scar uterus and placental placenta,which can lead to hemorrhage,shock,DIC,hysterectomy and even death.With the opening up of the two-child policy in our country,the incidence of pernicious placenta previa is rising year by year,also the postpartum blood loss,blood transfusion,uterus resection rate,neonatal asphyxia were higher than patients with normal placenta previa,which can lead to perioperative blood loss and blood coagulation dysfunction on maternal and threat fetal safety of life.How to reduce intraoperative blood loss and postoperative complications,improve perioperative blood coagulation function has become one of the most concern in the obstetrician and anaesthesian.Aim at solving the problem of massive hemorrhage,the main method is to change operation ways,use contractive uterus drugs and preoperative interventional embolization,but followed by high risk of infection and complications,and greatly increased the economic burden of maternal.Using hemostatic drugs to reduce bleeding is one of our concerns.Tranexamic acid(tranexamic acid,TXA)is a kind of antifibrinolytic medicine,can be combined with lysine binding site of plasminogen,the plasminogen lost the ability to combine with the fibrin,results in the decrease of fibrinolytic activity,which play a role of the bleeding.It is widely recommended to be used for postpartum hemorrhage,but preventive use in cesarean section is rarely reported at home and abroad.Perioperative patients with massive hemorrhage usually involving intraoperative blood transfusion and using blood clotting drug,which have led to the possibility of blood coagulation dysfunction,using point-of-care technology to monitor patients with blood clotting function,can accurately guide the infusion of blood products,determine whether the patient in a state of hypercoagulation or hypocoagulation.Sonoclot analyzer,which is invited in 1975 by Von Kualla,can provide all information of coagulation process,including coagulation,formation of fibrinogen and fibrinolysis.As a kind of instant coagulant function monitoring tool,it has been increasingly applied in clinical work,providing the dynamic process of blood coagulation in patients but little used in obstetrics.Be used for cesarean section,not only can quickly understand the patient’s blood coagulation function,can help to guide component transfusion,make patients get maximum benefit,reduce the waste of clinical blood products.Methods30 patients were selected to be diagnosed with a pernicious placenta previa,which were randomly taken into test group and control group,and combined descending cesarean section in obstetrics,anesthesiology,blood transfusion department and interventional department.Two groups of patients were doing a center vein puncture,and taking the center vein blood 3-5 ML(Milliliter,ML),immediately after taking blood from staff according to the rules of operation for the SCA measurement analysis.The test group used tranexamic acid injection 200 ML intravenous drip,drip 20 minutes;The control group used 0.9%sodium chloride injection 200ML intravenous drip,and the infusion was completed within 20 minutes.The choice of anesthesia in intraoperative anesthesia was carried out according to the management plan of the pernicious placenta previa.After surgery,the analysis was performed on the SCA assay,and the intraoperative blood loss,blood transfusion volume and hysterectomy were observed,complications were observed within 24 hours of follow-up.ResultsThe CR value of the test group was(38.40 + + 5.61)U/min after the treatment of tranexamic acid,higher than the control group(34.00-8.20)U/min;The PF value of the test group was(2.50 + 0.69),higher than the control group(2.00 + 0.90),and the.difference between the two groups was statistically significant(P<0.05).The loss of blood in the test group was(2384.67 ± 510.30)ml,lower than the control group(2999.20 ± 548.09)ml,and the difference between the two groups was statistically significant(P<0.05).The hysterectomy and blood transfusion were lower in the test group than in the control group.Conclusion1.In patients with obstetric hemorrhage who use tranexamic acid can improve perioperative blood coagulation function,reduce consumption of fibrinogen and platelet,sharply reduced intraoperative blood loss and blood transfusion,greatly saved the blood resources,reduced the incidence of transfusion related complications.2.The use of tranexamic acid in patients with hypercoagulation does not increase the incidence of thrombosis and other adverse reactions.3.Using point-of-care monitoring technology to measure coagulation function in patients with massive hemorrhage of obstetrics,it is beneficial to the blood management in the operation,guiding the blood transfusion,and the most reasonable application of blood resources.4.1t is recommanded that autologous blood transfusion should be widely used in obstetric surgery.