卡前列素防治高危产妇剖宫产术中及术后出血的临床研究

Clinical study on prevention of postpartum hemorrhage of cesarean section using hemabat in high risk pregnant women

目的观察卡前列素治疗有出血高危因素的产妇剖宫产术中、术后出血的有效性和安全性。方法对469例有出血高危因素(包括双胎、羊水过多、巨大儿、前置胎盘)的产妇行计划性剖宫产术。其中巨大儿239例,双胎+羊水过多145例,前置胎盘73例。术中胎儿娩出后随机按宫缩剂使用情况分为3组,缩宫素组152例,缩宫素20 U 于宫体注射,另20 加入液体中静脉滴入;缩宫素+卡前列素组192例,缩宫素20 U+卡前列素250 μg宫体注射;卡前列素组125例,卡前列素250μg于宫体注射。计算3组术中、术后2 h 出血量及总出血量,并观察3组的副反应。结果 (1)3组产妇术中出血量分别为,缩宫素组(445±262)ml,缩宫素+卡前列素组(332±218)ml,卡前列素组(375±265)ml,缩宫素组分别与缩宫素+卡前列素组和卡前列素组比较,差异有统计学意义(P<0.01,P<0.01)。(2)3组产妇术后2 h 出血量分别为,缩宫素组(176±193)ml,缩宫素+卡前列素组(110±114)ml,卡前列素组(124±103)ml,缩宫素组分别与缩宫素+卡前列素组和卡前列素组比较,差异有统计学意义(P<0.01,P<0.01),缩宫素+卡前列素组与卡前列素组比较,差异无统计学意义(P>0.05)。(3)3组产妇中,总出血量≥1000 ml 共31例,其中缩宫素组15例(48%),缩宫素+卡前列素组7例(23%),卡前列素组9例(29%)。(4)3组不同高危因素产妇出血量比较:缩宫素组中巨大儿产妇总出血量明显多于缩宫素+卡前列素组和卡前列素组(P<0.01,P<0.01);缩宫素组中双胎+羊水过多产妇术后2 h 出血量明显多于缩宫素+卡前列素组和卡前列素组(P<0.01,P<0.01);缩宫素组中前置胎盘产妇术后2 h 出血量明显多于缩宫素+卡前列素组(P<0.01)。(5)总出血量≥1000 ml 的巨大儿产妇12例,双胎产妇11例,前置胎盘产妇8例,无一例切除子宫。(6)副反应发生率缩宫素组为2.6%(4/152),缩宫素+卡前列素组为11.5%(22/192),卡前列素组为7.0%(9/125),后两组以呕吐为常见,短时间好转。结论卡前列素用于有出血高危因素产妇的剖宫产术可明显减少术中、术后出血量,与缩官素联合应用效果更好。

Objective To observe the effect and safety of hemabat （H） on prevention of postpartum hemorrhage in cesarean section and after cesarean section in high risk pregnant women. Methods Four hundred and sixty-nine pregnant women with high hemorrhagic risk factors including twin pregnancy, polyhydramnios, fetal macrosomia, placenta previa were planned cesarean section. A total of 457 pregnant women were divided into 3 groups by operation indications. There were 239 cases of fetal macrosomia, 145 cases of twin pregnancy and polyhydramnios, and 73 cases of placenta previa. Three kinds of hysterotonics were used randomly in each group. Group oxytocin （O） ： 20 U oxytocin injected into the uterine plus 20 U oxytocin intravascularly, 152 women; Group oxytocin ± hemabate （ O ± H） ： 20 U oxytocin and 250 μg hemabat injected into the uterine, 192 women; group H： 250 μg hemabat, injected into the uterine, 125 women. The amount of bleeding during the operation and within 2-hour after delivery were measured. The side effect of each group was observed. Results The amount of bleeding during cesarean section in group O was （445 ±262） ml, in group O ＋ H （332 ±218） ml, and in group H （375 ±265） ml. There was an extremely significant difference between group O and group O ＋ H （ P 〈 0. 01 ）. The amount of bleeding within 2 hours after delivery in group O was （ 176 ± 193） ml, in group O ＋ H was （ 110 ± 114） ml, and in group H was （124 ± 103） ml. There was a significant difference between groups O, O ＋ H and H. Among the 469 women, 31 had total amount of bleeding more than 1000 ml during operation and within 2 hours after delivery. 48% （ 15 women） were in group O, 23% in group O ＋ H and 29% in group H. The total amount of bleeding in group O was much more than group O ＋ H and group H in the group of fetal macrosomia （ P 〈 0. 01 ,P 〈0. 01 ）. Similar results were found in the group of twin pregnancy and polyhydramnios （P 〈0. 01, P 〈0. 01 ）. The total amount bleeding in group O ＋ H was much less than group O in the group of placenta previa （ P 〈 0. 05 ）. There were 5% （12） pregnant women whose total amount of bleeding was ≥ 1000 ml in the group of fetal macrosomia, 8% （11） in the group of twin pregnancy, 11% （8） in the group of placenta previa. No hysterectomy was done among the women. The incidence of side effects in the three groups was 2. 6%, 11.5% and 7.0% respectively. Vomiting was frequently seen in the latter two groups, but recovered soon without treatment. Conclusion Hemabat can significantly reduce the amount of bleeding during the cesarean section in pregnant women with high hemorrhagic risk factors and can be used with oxytocin as fimtline medicine to prevent hemorrhage during and after delivery.