抗纤溶药物用于减少分娩出血量的临床研究

A clinical study on antifibrinolytics on decrement of postpartum bleeding

目的 评价抗纤溶药物用于减少分娩出血量的有效性和安全性。方法 对120例阴道分娩的初产妇随机分为氨甲环酸组(A组:氨甲环四+缩宫素)、氨甲苯酸组(B组:氨甲苯酸+缩宫素)和缩宫素组(C组:缩宫素),观察第三产程和第四产程出血量,并分别于产前(第一产程)、产后半小时和产后2h检测血纤维蛋白原(FBG)及D-二聚体(D-dimer)。结果 ①3组间第四产程出血量差异有显著性(P<0.01);总出血量差异有显著性(P<0.05);A组少于C组。②各组间血纤维蛋白原无统计学差异,各组间D-dimer差异非常显著(P<0.001),A组产后2h高于产前(P<0.05),但与产后半小时无差异;B组的产后半小时及产后2h无差异,但均高于产前;C组产后2h高于产后半小时(P<0.05),明显高于产前(p<0.01),且高于A组产后2h(P<0.05)。③3组均无血栓发生。结论 阴道分娩后,在使用宫缩剂的基础上,适当使用抗纤溶药物可以抑制D-dimer浓度的上升,减少产后出血量。

Objective To study the effective and safety of antifibrinolytics on decrement of postpartum bleeding. Methods One hundred and twenty cases of primipara with vaginal deliveries were randomly divided into tranexamic acid group (group A: pitocin + tranexamic acid), aminomethylbenzoic acid group (group B: pitocin + aminomethylbenzoic acid) and pitocin group (group C: pitocin) . The amount of postpartum bleeding was collected and measured carefully within the third stage of labor and the forth stage of labor. Fibrinogen and D - dimer were examined during antepartum (the first stage of labor) , half an hour postpartum and 2 hours postpartum respectively. Results (1) The postpartum blood loss in the forth stage of labor of group A was significantly lower than that of group C ( P < 0.01), total postpartum blood loss of group A was significantly lower than C group ( P < 0.05) . (2) Fibrinogen among the different groups showed no significant difference statistically ( P > 0.05), however D - dimer was significantly different ( P < 0.001) . In group A, D -dimer of 2 hours postpartum was significantly higher than that of antepartum ( P < 0.05), but is not statistically significant with that of half an hour postpartum. In group B, D - dimer of half an hour and 2 hours of postpartum were both significantly higher than that of antepartum ( P < 0.05) . In group C, D - dimer of 2 hours postpartum was higher than that of half an hour postpartum ( P < 0.05) , also significantly higher than that of antepartum ( P < 0.01) , and was higher than that of 2 hours postpartum of group A ( P < 0.05) . (3) No thromboembolism appeared in any group. Conclusions Routine use of pitocin after vaginal deliveries with proper antifibrinolytics can depress the rise of D -dimer and decrease postpartum bleeding.