米索前列醇用于预防经阴道自然分娩产后出血的研究

Study on misoprostol for prevention of postpartum hemorrhage after natural vaginal delivery

目的:比较米索前列醇两种不同用药途径用于预防经阴道自然分娩产后出血的临床效果和不良反应。方法:2007年2月～2009年2月在宁波市妇女儿童医院分娩的产妇中,随机选择37～42周妊娠正常分娩、单胎头位、无妊娠合并症或并发症,未用过前列腺素抑制剂的产妇822例,随机分为米索前列醇舌下含化组、直肠用药组,每组各411例。舌下含化组于胎儿前肩娩出后立即舌下含化米索前列醇600μg;直肠用药组于胎儿前肩娩出后立即深部肛塞米索前列醇600μg,测量产后24 h出血量,分娩前后的血色素及红细胞压积,监测产妇分娩前后的血压、脉搏及寒战、发热、恶心、呕吐、头痛、腹泻等不良反应,如果阴道流血量较多则立即静脉推注缩宫素10 IU。结果:产后24 h阴道出血量舌下含化组明显低于直肠用药组,产后出血发生率舌下含化组低于直肠用药组,红细胞压积下降≥10%的比例、血色素下降≥30 g/L的百分比及加用缩宫素的比例,舌下含化组小于直肠组,差异有统计学意义(P<0.05)。寒战及发热的发生率舌下含化组高于直肠用药组(P<0.05)。结论:600μg米索前列醇预防经阴道自然分娩产后出血,舌下含化组效果优于直肠用药组,寒战及发热发生率舌下含化组高于直肠用药组。

Objective： To compare the clinical efficacy and adverse reaction of misoprostol for the prevention of postpartum hemorrhage after natural vaginal delivery with two different routes of administration. Methods： 822 pregnant women （37 - 42 gestational weeks, single pregnancy, cephalic presentation, no pregnant complications, never using prostaglandin inhibitor） were selected from the hospital from February 2007 to February 2009, then they were divided into sublingual treatment group and rectal treatment group, 411 cases in each group. The cases in sublingual treatment group put 600 ug of misoprostol under the tongue as soon as the fetal anterior shoulder was delivered; while the cases in rectal treatment group put 600 ug of misoprostol into rectum deeply as soon as the fetal anterior shoulder was delivered ; the amount of blood loss within 24 hours after delivery, the levels of hemachrome and HCT before and after delivery were detected ; the blood pressures, pulse rates and the incidences of complications including shiver, fever, nausea, vomiting, headache and diarrhea before and after delivery were monitored; the cases with large vaginal bleeding were treated with intravenous injection of oxytocin （10 U） . Results： The amount of blood loss within 24 hours after delivery in sublingual treatment group was significantly lower than that in rectal treatment group, the incidence of postpartum hemorrhage in sublingual treatment group was significantly lower than that in rectal treatment group, the proportions of the decrease of HCT≥10% , the decrease of hemachrome≥30 mg/L and cases using oxytocin in sublingual treatment group were significantly lower than those in rectal treatment group （ P 〈 0. 05 ）. The incidences of shiver and fever in sublingual treatment group were significantly higher than those in rectal treatment group （P 〈 0. 05）. Conclusion ： Sublingual treatment group （600 ug misoprostol） is superior to rectal treatment group （600 ug misoprostol） in preventing postpartum hemorrhage after transvaginal spontaneous labor, the incidences of shiver and fever in sublingnal treatment group are significantly higher than those in rectal treatment group.