产时胎儿手术应用欣母沛预防母体产后出血的临床研究

Analysis of clinical effect of hemabate during the fetal intrapartum operation

目的观察在产时胎儿手术中应用欣母沛的母体产后出血量及预后,探讨产时胎儿手术预防产时和产后出血的最佳措施及在产时胎儿手术中应用欣母沛的可行性和安全性。方法回顾性分析2008年8月-2010年12月成功施行产时胎儿手术的15例患者[产时胎儿手术组(IFO组),n=15],其中应用缩宫素+卡孕栓者7例(常规IFO组,n=7),应用欣母沛+缩宫素+卡孕栓者8例(欣母沛组,n=8),观察两组患者术中及术后24 h内出血量,术前和术后24 h的血红蛋白水平,宫缩情况,产褥感染的发生情况,产后42 d随访情况,并与同期因拒绝试产行择期剖宫产手术的10例健康孕妇进行对照。结果三组患者的子宫复旧情况均正常,均无早期及晚期产后出血的发生,无产褥感染发生。IFO组母体术中出血量、术后24 h及术中+术后24 h总出血量与对照组相比差异均无统计学意义(P>0.05)。其中欣母沛组术中出血量、术后24 h及术中+术后24 h总出血量显著少于常规组(P<0.05)。IFO组与对照组之间术前和术后及产后42 d复查的血红蛋白浓度差异均无统计学意义(P>0.05),而欣母沛组术前术后血红蛋白浓度差值显著低于常规组(P<0.05)。应用欣母沛后有1例出现腹胀,12 h后缓解;1例出现呃逆,6 h后消失,未见其他药物不良反应。结论于产时胎儿手术期间应用欣母沛较常规使用缩宫素可明显减少术中和产后出血量,是一项有效的预防产后出血的措施。

Objective To observe the postpartum hemorrhage amount and the prognosis after using the hemabate（H）during the fetal intrapartum operation,and to investigate a better way for preventing the intrapartum and postpartum hemorrhage and the feasibility and safety of hemabate in fetal intrapartum operation. Methods Fifteen cases that has been performed intrapartum fetal operation（IFO group,n=15）successfully were evaluated retrospectively from Aug 2008 to Dec 2010.The IFO group was divided into two groups,the regular group（R group,which used oxytocin and carboprost methylate and the hemabate group（H group,which used hemabate,oxytocin and carboprost methylate）.10 cases of healthy pregnant women were chose as control group,they received caesarean section refusing vaginal delivery during this period.The following indexes were recorded：blood lose during the operation and 24 hpost-operation,the variety of hemoglobin level before and 24 h post-operation,the uterine contraction state,the puerperal infection occurrence and the puerperal recovery at 42 d post-operation. Results The prognosis of the three groups were all satisfied with no postpartum primary and secondary hemorrhage and no puerperal infection.The blood lose of intra-operation and 24 h post-operation and the total volumes of blood lose intra-and post-operation 24 h of IFO group had no difference compared with those of control group（P0.05）.The results above in H group were significantly lower than R group（P0.05）.There was no significant difference in hemoglobin level before operation,at 24 h post-operation and 42 d post-operation between IFO group and control group（P0.05）.While the variation of hemoglobin levels before and after operation of H group were significantly lower than those of R group（P0.05）.The incidence of side effects included burbulence（1case,relieving after 12 h）and singultation（1 case,resolving after 6 h）,no treatment was needed. Conclusion Comparing with oxytocin,hemabate can decrease the hemorrhage of intra-operation and postpartum during the fetal intrapartum operation,and it is an effective measurement to prevent the postpartum hemorrhage during fetal intrapartum operation.