选择性剖宫产术后出血的药物控制研究

Comparison of the effectiveness and safety of carbetocin and oxytocin for the prevention of postpartum hemorrhage after caesarean section

目的比较1-脱氨基-1-单羟基-(2-氧-甲基酪氨酸)-催产素(卡贝缩宫素)与缩宫素控制剖宫产术后出血的效果及安全性。方法采用随机、开放、平行对照的方法。对接受选择性剖宫产216例随机分为试验组(卡贝缩宫素组)和对照组(缩宫素组)。胎儿娩出后,立即宫体注射10 IU缩宫素及小壶静滴10 IU缩宫素。皮肤缝合后,试验组(111例)单次静脉推注卡贝缩宫素100μg,1 min注完;对照组(105例)于2,000 ml溶液内加入20 IU缩宫素,静脉点滴,以250 ml/h的速度,输注8 h。采用称重法比较两组术后出血量、产后出血发生率,两组用药后血红蛋白浓度、肝肾功能、血糖及电解质的变化。结果两组术中平均出血量和术后24 h出血总量均无显著性差异;产后出血发生率、用药后血红蛋白浓度、肝肾功能、血糖以及电解质变化也无显著差异。结论卡贝缩宫素在控制选择性剖宫产术后出血与缩宫素同样有效,二者安全性相似。

Objective. To investigate the effectiveness and safety of carbetocin and oxytocin for the prevention of postpartum hemorrhage after selective caesarean section. Methods： This is a randomized controlled, prospective study. Total 216 women who underwent selective caesarean section were randomly put into two groups, 105 in the oxytocin group and 111 in the carbetocin group. 10 IU oxytocin was injected into the uterus and another 10 IU oxytocin was intravenously transfused immediately after delivery of baby in both groups. When the operation was finished, 20 IU oxy- tocin in 2,000 ml fluid was transfused intravenously to women in oxytocin group, and the infusion lasted for 8 hours. To women in carbetocin group, 100 μg carbetocin was injected intravenously and the injection finished in about 1 minute. Then, the blood loss and hemoglobin level of the women were compared to determine the effectiveness of carbetocin. The function of liver and kidney, the glucose of the plasma were also compared to determine the safety of carbetocin. Results： The mean blood loss during operation and in the 24-hour postpartum had no significant difference between the two groups. The incidence of postpartum hemorrhage and the change of hemoglobin concentration after operation had no significant difference between the two groups. The blood biochemical indicators such as the liver enzyme, the blood urea nitrogen, the blood creatinine and the blood glucose were normal in the two groups. Conclusion： The effectiveness of carbetocin and oxytocin is similar with loss of selective caesarean section, and cabetocin is well tolerated.