NO、NOS与宫缩乏力性产后出血关系的研究

The relationship between NO,NOS and postpartum hemorrhage caused by uterine inertia

目的:探讨血清NO及NOS在预测宫缩乏力性产后出血发生发展中的作用。方法:选择剖宫产终止妊娠的孕妇180例,因臀位、社会因素、骨盆狭窄、胎儿宫内窘迫等行剖宫产术,按产后24 h内出血量≥500 m l分为产后出血组(n=47)及非产后出血组(n=133)。所有孕妇于剖宫产术麻醉前30 m in及术后2 h测血清NO及NOS,术中娩出胎儿后于子宫切缘上缘及胎盘母体面中央无钙化区分别取子宫肌组织及胎盘组织各一,切片作免疫组织化学分析iNOS的表达,准确收集剖宫产术中出血量及产后24 h出血量。结果:产后出血组术前、术后血清NO及NOS含量较非产后出血组明显增高,差异有显著性意义(P<0.05);血清NOS预测产后出血的灵敏度、特异度、阳性预测值、阴性预测值均高于血清NO值;从SABC免疫组化结果可见在子宫肌及胎盘均有iNOS表达,产后出血组子宫肌和胎盘的iNOS阳性表达率均显著高于非产后出血组,P<0.05;经等级相关检验,子宫肌、胎盘组织iNOS的表达强度随术前血清NO、NOS水平的升高而增加,均呈正相关。结论:血清NO、NOS水平可以正确反映子宫、胎盘NOS的活性,可作为预测宫缩乏力性产后出血的1项有效的指标。

Objective： To investigate the level of NO and NOS in serum can predict the occurrence and development of postpartum hemorrhage caused by uterine inertia. Methods： 180 patients underwent a cesarean delivery for reasons of breech presentation, social factors, stenosis pelvis, fetal distress were selected. They were classified in bleeding group （n =47） and normal group （n = 133） according to the criteria of postpartum hemorrhage defined as blood loss in excess of 500ml within 24 hours following delivery. These pregnant women of NO and NOS in serum were detected in 30 minutes before narcosis and 2 hours after operation. Volume of blood loss during cesarean section and 24 hours after delivery were collected accurately. Tissue samples of myometrium and placenta strip were obtained from the upper margin in the uterine incision and from the middle of placenta respectively during cesarean, lmmunohistochemistry SABC was applied to examine the activity of iNOS in myometrium and in placenta. Results： The level of NO and NOS in serum before and after operation of bleeding group was significantly higher than that of normal group （ P 〈 0. 05）. For predictive value for postpartum hemorrhage, the sensitivity, specificity, positive predictive value and negative predictive value of NOS in serum had a better than that of NO in serum. The expression of iNOS in both myometrium and placenta were significantly higher in bleeding group than in normal group （P 〈0. 05 ）. The positive rates of iNOS expression in myometrium and placenta elevated as the level of NO and NOS in serum. Conclusion： The level of NO and NOS in serum can accuracy reflect the activity of iNOS in myometrium and placenta and may become a valuable index for forecasting atonic bleeding.