两种不同方法应用欣母沛预防剖宫产产后出血的临床观察

Clinical observation on hemabate in prevention of postpartum hemorrhage after cesarean section by two different application methods

目的:观察欣母沛对合并有产后出血高危因素的剖宫产孕产妇产后出血的防治效果和安全性。方法:选择合并有羊水过多、双胎妊娠、巨大胎儿、宫缩乏力、前置胎盘等产后出血高危因素的孕产妇90例,随机分为对照组(胎儿娩出后只常规静滴催产素)、肌注欣母沛组(胎儿娩出后常规静滴催产素的基础上,同时三角肌内注射欣母沛)、宫体注射欣母沛组(胎儿娩出后常规静滴催产素的基础上,同时子宫肌层内注射欣母沛)各30例。比较各组术中、产后2 h及产后24 h的出血量、产后出血的发生率以及副反应。结果:肌注欣母沛组和宫体注射欣母沛组产后出血的发生率分别为16.7%和13.3%,明显低于对照组的36.7%(P<0.01),两组术中、产后2 h和产后24 h平均出血量也均明显少于对照组,差异有统计学意义(P<0.01),肌注欣母沛组和宫体注射欣母沛组的副反应总发生率明显高于对照组36.7%(P<0.01),肌注欣母沛组的副反应总发生率高于宫体注射欣母沛组(P<0.05)。发生副反应的孕产妇均可自行恢复,无严重并发症发生。结论:对合并有产后出血高危因素的剖宫产孕产妇术中预防性使用欣母沛,明显减少了术中和产后出血量,降低了产后出血的发生率,两种使用方法均疗效确凿、安全性好,值得各级医院推广。

Objective：To observe the efficacy and security of hemabate in prevention and treatment of postpartum hemorrhage after cesarean section among the pregnant women combined with high risk factors of postpartum hemorrhage.Methods：90 pregnant women with high risk factors of postpartum hemorrhage（polyhydramnios,twin pregnancy,macrosomia,uterine inertia and placenta praevia） were selected and divided into 3 groups randomly： control group（routine intravenous drip of oxytocin after birth）,intramuscular injection of hemabate group（intramuscular injection of hemabate into deltoid based on routine intravenous drip of oxytocin after birth） and uterus body injection of hemabate group（uterus body injection of hemabate based on routine intravenous drip of oxytocin after birth）,30 pregnant women in each group;the amounts of blood loss,incidences of postpartum hemorrhage and adverse reactions during operation,at 2 and 24 hours after birth were compared among the three groups.Results：The incidences of postpartum hemorrhage in intramuscular injection of hemabate group and uterus body injection of hemabate group were 16.7% and 13.3%,respectively,which were significantly lower than that in control group（36.7%）（P〈0.01）.The average amounts of intraoperative blood loss in intramuscular injection of hemabate group and uterus body injection of hemabate group were significantly less than that in control group（P〈0.01）.The total incidences of adverse reactions in intramuscular injection of hemabate group and uterus body injection of hemabate group were significantly lower than that in control group（36.7%）（P〈0.01）.The total incidence of adverse reactions in intramuscular injection of hemabate group was significantly higher than that in uterus body injection of hemabate group（P〈0.05）.All the pregnant women with adverse reactions recovered without any management,no severe complications occurred.Conclusion：Preventive use of hemabate during operation can reduce the amounts of intraoperative and postoperative blood loss,incidence of postpartum hemorrhage among pregnant women with high risk factors of postpartum hemorrhage after cesarean section,the two different application methods are effective and safe,which is worth popularizing in hospitals at different levels.