益母草注射液辅助子宫前后壁贯穿缝合术防治高危难治性产后出血的临床研究

Clinical Study on Yimucao Injection Assisted Penetrating Suture of Anterior and Posterior Uterine Walls for Prevention and Treatment of High-risk and Refractory Postpartum Hemorrhage

目的 观察子宫前后壁贯穿缝合术后辅以益母草注射液防治高危难治性产后出血的临床疗效,并对其机制进行分析。方法 采用随机数字表法将46例于2017年11月17日-2018年9月25日收治的高危难治性产后出血产妇均分为对照组和观察组,对照组采用子宫前后壁贯穿缝合术联合缩宫素注射液治疗;观察组加用益母草注射液。比较两组产妇凝血功能、产后出血及子宫复旧情况。结果 治疗后观察组凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer,DD)、产后出血发生率、恶露持续时间、产后2 h和24 h出血量、产后第3天及随访42天子宫体积等指标均明显低于对照组,而内/外源性凝血因子Xa较对照组升高、宫缩持续时间延长、第1、3、5天宫底下降高度大于对照组相同观察时间点,且观察组术后2周宫腔积血程度明显好转,与对照组比较差异有统计学意义(P <0.05)。结论 术后联用益母草注射液可明显改善高危难治性产后出血产妇凝血功能并促进子宫复旧,明显提高临床疗效、降低产后出血的发生率。

Objective To observe the clinical efficacy of Yimucao injection in the prevention and treatment of high-risk refractory postpartum hemorrhage after uterine anterior and posterior wall sutures, and to analyze its mechanism. Methods A total of 46 high-risk refractory postpartum hemorrhage patients who were admitted to the hospital from November 17,2017 to September 25, 2017 were randomly divided into the control group and the observation group. The control group was treated with uterine anterior and posterior wall sutures. The operation was combined with oxytocin injection;the observation group was supplemented with motherwort injection. The coagulation function, postpartum hemorrhage and uterine involution were compared between the two groups. Results After treatment, prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrinogen(fibrinogen, FIB) were observed. D-dimer(DD),incidence of postpartum hemorrhage, duration of lochia, 2 h and 24 h postpartum hemorrhage, postpartum day 3 and 42 days of uterine volume were significantly lower than the control group. The internal/exogenous coagulation factor Xa was higher than the control group, the duration of contraction was prolonged, and the descending height of the uterus at the 1 st,3 rd, and 5 thday was higher than that of the control group, and the uterine cavity was observed 2 weeks after the observation. The degree of hemorrhage was significantly improved, and the difference was statistically significant(P <0.05). Conclusion Postoperative combined use of motherwort injection can significantly improve the coagulation function of high-risk refractory postpartum hemorrhage and promote uterine involution, significantly improve clinical efficacy and reduce the incidence of postpartum hemorrhage.