大剂量雌激素在剖宫产术后晚期产后出血治疗中的作用

Effect of high-does estradiol valerate on late stage postpartum hemorrage of caesarean section

目的探讨剖宫产术后晚期产后出血的有效药物保守治疗方法。方法选择2007年4月至2011年12月就诊于阜阳市人民医院产科的10例剖宫产术切口愈合不良致晚期产后出血患者,给予口服戊酸雌二醇4 mg,口服,每天3次;血止后每3天递减1/3量,至2 mg/d维持,21 d停药,后10 d加用口服黄体酮,同时给予抗生素、缩宫素及支持治疗。结果 9例患者1～3 d流血明显减少,3～10 d血止,撤退性出血量多于月经量,保守治疗1周期后痊愈出院,随访3～4个月经周期后患者基本恢复正常,除回乳及胃肠道反应外未见其他明显不良反应。1例患者在用药第2天再次出现大出血行介入治疗无效切除子宫。结论大剂量戊酸雌二醇可使子宫肌细胞增生、变厚,血运增加,可加快子宫切口修复愈合,同时可使子宫收缩力增强及增加子宫平滑肌对缩宫素的敏感性,减少出血,达到治愈的目的,为保守治疗提供实用有效的方法。

Objective To investigate the effective conservative treatment with drugs for late postpartum hemorrage of caesarean section.Methods Ten cases of late stage postpartum hemorrage caused by abnormal incision healing of caesarian section admitted in people＇s hospital of fupang from April 2007 to December 2011 were choosed.The patients received estradiol valerate 4 mg,po,tid,after blood stopping the dose was reduced by one-third every three days,2 mg daily maintained for 21 days.In the last 10 days,progesterone was given orally in order to induce the menstruation.Antibiotic,intravenous oxytocin and other supportive treatment were also given.Results Nine patients obtained success in bleed stopping at 3th or 10th Day,with drawal bleeding volume were more than menstruation.The side effects were suppressinon of lactation and gastrointestinal reaction.One patient received surgical removement of the uterus after the failure of the interventional therapy for recurrent hemorrhage at the 2nd day of medication.Conclusion High-does estradiol valerate can make hyperplasia of the cellular of uterus muscle,increase blood circulation to reduce the time of healing of uterus incision.It also has effect of stimulating uterus to contract,enhancing chemosensitivity of the uterine smooth muscle to intravenous oxytocin in order to reduce bleeding.In a word,high-does estradiol valerate is a very effective conservative treatment for late stage postpartum hemorrage of caesarean section.