米索前列醇预防选择性剖宫产产后出血的临床观察

Prevention of postpartum bleeding of elective cesarean section by misoprestol

目的探讨舌下含服米索前列醇预防剖宫产产后出血的效果。方法将妊娠晚期单胎选择性剖宫产者180例随机分为三组,为组1、组2和组3,分别用米索前列醇配合催产素,单用催产素和单用米索前列醇。观察术中及产后2 h内平均出血量和用药前后收缩压、舒张压、平均动脉压及产前产后血红蛋白的变化。结果术中及术后2 h内平均出血量,组1、组2和组3分别为(185.3±50.7)ml和(203.2±53.7)ml、(267.2±49.1)ml和(324.8±60.3)ml(、256.8±46.4)ml和(320.3±57.4)ml。组1与组2及组3比较差异有统计学意义(P<0.05)。组2与组3比较差异无统计学意义(P>0.05)。比较用米索前列醇前后,三组收缩压、舒张压、平均动脉压变化差异无统计学意义(P>0.05)。三组术前、术后血红蛋白差异无统计学意义(P>0.05)。结论舌下含服米索前列醇促进子宫收缩作用与催产素相似,配合催产素可更有效地减少和预防产后出血。对于血压无影响可用于有心血管变化的高危产妇。

Objective To observe the effect of oral misoprostol on the prevention of postparrum bleeding of cesarean section. Methods One hundred and eighty patients in late single pregnancy selective cesarean were randomized into three groups. Group 1（60 cases） received 600μg misoprostol and oxytocin 10 IU. Group 2（60 cases） received intravenous infusion of oxytocin 20 IU. Group 3（60 cases） received 600μg misoprostol. The amount of bleeding in the operation, within 2 hours after delivery and blood pressure change before/after giving misoprostol, haemoglobin of patients before and alter delivery were observed. Results The amount of postpartum bleeding in the operation and within 2 hours ware （185.3±50.7） ml and （203.2±53.7） ml, （267.2±49.1）ml and （324.8±60.3） ml, （256.8± 46.4） ml and （320.3±57.4） ml in three groups respectively. The difference in the amount of bleeding between group 1 and group 2, group 3 was obvious （P〈O. 05）. The difference in the amount of bleeding between group 1 and group 2 was no obvious（P 〉0.05）. There were no obvious change in blood preasure and henaoglobin concentration（P〉0.05）. Conclusion Oral misoprostol alone is as effective as oxytocin alone for the prevention of postpartum hemorrhage. It is less effective than oral misoprostol plus oxytocin. Misoprostol is applicable for high risk pregnancy with some vascular changes.