瘢痕子宫妊娠产后出血的防治措施比较研究

Comparative study on prevention and treatment of postpartum hemorrhage in scar uterus pregnancy

目的比较不同措施对瘢痕子宫妊娠产后出血的防治效果,并分析母婴不良预后情况。方法收集2019年5月至2019年11月我院收治的瘢痕子宫再次妊娠行剖宫产术分娩的产妇96例,随机分为两组,其中对照组48例于胎儿娩出后给予缩宫素20 IU子宫肌内注射,研究组48例于胎儿娩出后在对照组基础上给予卡贝缩宫素100μg的0.9%氯化钠注射液快速持续静脉滴注。比较两组产妇的术中出血量、产后2 h、产后24 h的出血量以及是否使用其他止血干预,并观察产妇不良反应及新生儿状况,对安全性进行评估。结果研究组产妇的术中出血量、产后2 h、产后24 h出血量以及血红蛋白下降水平均明显低于对照组(P<0.05),此外,研究组患者需要其他止血干预的例数明显低于对照组(P<0.05),差异均存在统计学意义;研究组产妇的头痛、呕吐和皮肤瘙痒等不良反应发生率均明显低于对照组(P<0.05),而腹痛、恶心的发生率两组间无明显差异(P>0.05)。两组间新生儿窒息的发生率无明显差异(P<0.05)。结论瘢痕子宫妊娠剖宫产术中联合使用卡贝缩宫素和缩宫素可以更好地控制术中及产后出血量,并且可相应减少产妇不良反应发生及新生儿窒息率,值得临床进一步应用推广。

Objective Objective to compare the preventive and therapeutic effects of different measures on postpartum hemorrhage of scar uterus and analyze the adverse prognosis of mother and infant.Methods Collected from May 2019 to November 2019 in our hospital treated with cesarean scar pregnancy again cesarean section delivery of maternal 96 cases,randomly divided into two groups,of which 48 cases in the control group were given intrauterine injection of oxytocin 20 IU uterus after the fetus was delivered,in the study group,in the study group,48 cases were given fast sustained intravenous infusion of carbetocin 100μg 0.9%sodium chloride injection on the basis of the control group after the fetus was delivered.The two groups of maternal intraoperative blood loss,postpartum 2 h,24 h of bleeding and whether to use other hemostatic intervention,and observe the maternal adverse reactions and neonatal conditions,to assess the safety.Results In the study group,the intraoperative blood loss,the amount of hemorrhage 2 h and 24 h postpartum,and the hemoglobin level in the study group were significantly lower than those in the control group(P<0.05).In addition,the number of patients who needed other hemostatic interventions in the study group was significantly lower than that in the control group(P<0.05),and the differences were statistically significant.The incidence of adverse reactions such as headache,vomiting and pruritus in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference between the two groups in the incidence of abdominal pain and nausea(P>0.05).There was no significant difference in neonatal asphyxia between the two groups(P<0.05).Conclusion Cesarean scar pregnancy and cesarean section combined use of carbetocin and oxytocin can better control intraoperative and postpartum hemorrhage,and can also reduce the incidence of maternal adverse reactions and the rate of neonatal asphyxia,it is worth further clinical application.