卡前列腺素联合高渗晶胶混合液治疗剖宫产宫缩乏力所致术中及术后出血的临床观察

Prevention of Postpartum Hemorrhage Caused by Uterine Inertia during Cesarean Section Using Carboprost Combined with Hypertonic and Hyperoncoctic Solution

目的观察卡前列腺素联合高渗晶胶混合液治疗剖宫产宫缩乏力所致出血的效果。方法 94例剖宫产患者,根据促子宫收缩药物使用以及补液成分不同分为3组:(1)缩宫素+晶体液组:给予缩宫素20 U子宫体注射,10 U加入250 ml 0.9%氯化钠溶液快速静脉滴注,同时给予乳酸林格液2 000 ml快速滴注;(2)缩宫素+晶体液+胶体液组:给予缩宫素20 U子宫体注射,10 U加入250 ml 0.9%氯化钠溶液快速静脉滴注,同时给予乳酸林格液1 000ml、羟乙基淀粉1 000 ml快速滴注;(3)缩宫素+卡前列腺素+高渗晶胶混合液组:给予缩宫素20 U和卡前列腺素250μg子宫体注射,同时给予乳酸林格液1 000 ml、高渗氯化钠羟乙基淀粉40注射液500 ml。观察术中、术后2 h、术后24 h的出血量、血流动力学状态、尿量及进一步治疗措施。结果缩宫素+卡前列腺素+高渗晶胶混合液组较其他两组比较术中出血量明显少,24 h血流动力学平稳,进一步治疗的病例数明显减少,差异均有统计学意义(P<0.05)。结论给予卡前列腺素以及联合使用胶体液或者高渗晶胶混合液用于治疗剖宫产中宫缩乏力所致的出血,能够较好地减少出血量、有效维持血流动力学的稳定,预后较好。

Objective To observe the effectiveness of carboprost combined with hypertonic and hyperoncoctic solution（HHS） in preventing postpartum hemorrhage caused by uterine inertia during cesarean section.Methods Totally 94 pregnant women who were undergoing Cesarean section were divided into three groups based on the application of the uterotonics and the fluid infusion： oxytocin and lactated Ringer＇s group（oxytocin 20 IU injected into the uterine and oxytocin 10 IU infused intravenously in 250 ml saline,combined with 2000 ml lactated Ringer＇s infused intravenously）,oxytocin plus lactated Ringer＇s plus colloid solution group（oxytocin 20IU injected into the uterine and oxytocin 10IU infused intravenously in 250 ml saline,combined with 1000 ml lactated Ringer＇s and 1000 ml hydroxyethyl Starch 130/0.4,and sodium chloride injection intravenously infused） and oxytocin plus carboprost plus hypertonic and hyperoncoctic solution group（oxytocin 20 IU and carboprost 250 μg injected into the uterine,combined with 1000 ml lactated Ringer＇s and 500 ml hypertonic sodium chloride hydroxyethyl starch 40 injection infused intravenously）.The blood pressure,heart rate,volume of blood loss,urine volume,and other hemodynamic parameters were measured.Results Compared with the oxytocin plus lactated Ringer＇s group and the oxytocin plus lactated Ringer＇s plus colloid solution group,the carboprost plus hypertonic and hyperoncoctic solution group had significantly less intra-operative blood loss,stabler hemodynamics,and less cases required further treatment（all P〈0.05）.Conclusion Carboprost combined with HHS can effectively prevent postpartum hemorrhage caused by uterine inertia during Cesarean section by decreasing blood loss and maintaining the hemodynamic stability.