米索前列醇不同给药方式联合缩宫素预防产后出血的临床研究

Therapeutic effect of different administrated misoprostol combined with oxytocin on prevention of postpartum hemorrhage

目的探讨米索前列醇不同给药方式联合缩宫素预防产后出血的临床效果。方法选择2009年1月—2010年9月经阴道分娩的150例足月妊娠产妇,随机分为米索前列醇直肠给药组、舌下给药组和对照组。直肠给药组50例,在胎儿娩出后立即给予米索前列醇直肠给药与缩宫素静脉推注联合应用;舌下给药组50例,在胎儿娩出后立即给予米索前列醇舌下含化与缩宫素静脉推注联合应用;对照组50例在胎儿娩出后仅给予缩宫素静脉推注。观察3组产后2h、24h内的出血量,并进行对比分析。结果直肠给药组产后2h、24h平均出血量分别为(129.8±20.5)ml和(248.4±35.2)ml,舌下给药组分别为(128.4±16.6)ml和(241.6±25.2)ml,对照组则为(164.6±44.6)ml和(290.8±50.4)ml;直肠给药组、舌下给药组明显少于对照组(P<0.01),而直肠给药组、舌下给药组比较差异无统计学意义(P>0.05)。3组均无产后出血发生,亦未出现严重不良反应。结论联合应用米索前列醇和缩宫素预防阴道分娩产后出血明显优于单用缩宫素,且安全性好。米索前列醇舌下给药与直肠给药效果无明显差异。

Objective To investigate clinical therapeutic effect of combination of misoprostol and oxytocin for prevention of postpartum hemorrhage.Methods 150 parturient women who vaginally delivered in our hospital from January 2009 to September 2010 were randomly divided into three groups include rectal misoprostol group,oral misoprostol group and control group.Rectal misoprostol group（n=50） were rectally administrated misoprostol immediately after the fetus was delivered out,and then intravenously injected oxytocin.Oral misoprostol group（n=50） were sublingually administrated misoprostol immediately alter the fetus was delivered out,and then intravenously injected oxytocin.Control group（n=50） were only intra venously injected oxytocin immediately after the fetus was delivered out.The estimated mean blood loss of delivery women in three groups at 2 hours and 24 hours after delivery were compared.Results The estimated mean blood loss of rectal misoprostol group was（129.8±20.5） ml at 2 h and（248.4±35.2） ml at 24 h after delivery respectively,while in the oral misoprostol group was（128.4±16.6） ml at 2 h and（241.6±25.2） ml at 24 h after delivery respectively,and in control group was （164.6±44.6） ml at 2 h and（290.8±50.4） ml at 24 h after delivery respectively.There were significant differences between rectal misoprostol group,oral misoprostol group compared with control group separately（all of the P0.01）.There was no significant difference between rectal misoprostol group and oral misoprostol group（P0.05）.There was no postpartum he morrhage happened among three groups.Conclusion Combination of misoprostol and oxytocin for prevention of vaginal bleeding after delivery is more effective than single using of oxytocin.There were no significant differences of effect between rectally administrated and sublingually administrated of misoprostol.