米索前列醇和催产素联合使用对产后血管紧张素Ⅱ和凝血因子的影响

Influence of Misoprostol Combined with Oxytocin on the Serum Levels of AngiotensinⅡ and Coagulation Factors after Parturient Postpartum

目的:探讨联合使用米索前列醇和催产素对产妇产后血管紧张素Ⅱ(AngⅡ)和凝血因子的影响,为产后出血治疗提供依据。方法:选择我院妇产科2010年12月1日—2013年1月1日收治的120例具有产后出血高危因素(妊娠期高血压疾病,胎盘早剥,前置胎盘,巨大儿,多胎妊娠)的产妇为研究对象,随机分成A、B、C组,每组40例。A组产妇在胎儿娩出后立即通过直肠给予米索前列醇400μg;B组产妇在胎儿娩出后立即宫体肌内注射催产素20 U,同时20 U催产素加入10%葡萄糖注射液中进行缓慢静脉滴注;C组产妇在胎儿娩出后立即宫体肌内注射催产素20 U,同时米索前列醇400μg直肠给药。采用容积法和称重法测量3组产妇产后2,24 h时出血量,并测量3组产妇产前、产后血液中AngⅡ和凝血因子Ⅷ、Ⅸ水平,记录产妇分娩前和胎盘娩出后2 h收缩压情况。结果:A、B两组产妇产前和产后血液中AngⅡ比较差异无统计学意义(P>0.05);C组产妇产后血液中AngⅡ较产前增高(t=7.196,P=0.009)。A、B两组产妇产前血液中的凝血因子Ⅷ和Ⅸ水平比较差异无统计学意义(均P>0.05),C组产妇血液中的2种凝血因子水平产后高于产前(均P<0.05)。3组产妇产后2 h和产后24 h出血量比较差异有统计学意义(均P<0.05)。3组产妇产前和产后2 h收缩压比较差异无统计学意义(均P>0.05)。结论:米索前列醇和催产素联合使用能提高产妇产后血液中血管紧张素和凝血因子水平,有效抑制产后出血。

Objective：To investigate the influence of misoprostol combined with oxytocin on serum levels of angiotensinⅡ （Ang Ⅱ ） and coagulation factors after parturient postpartum,which is a useful reference for effective treatment of postpartum hemorrhage. Methods： 120 parturients with postpartum hemorrhage from our hospital during Dec 2010 to Jan 2013 were included in this study. Those high-risk factors were pregnancy hypertension,placental abruption,placenta previa, fetal macrosomia and multiple pregnancy. Those cases were randomly divided into three groups,each with 40 cases. Parturients in group A were immediately administrated with misoprostol 400 μg through rectum after baby delivery. Parturients in group B were immediately administrated with oxytocin 20 U through palace intramuscular, at the same time,with oxytocin 20 U through intravenous infusion. Parturients in group C were immediately administrated with oxytocin 20 U through palace intramuscular and misoprostol 400μg through rectum. The postoperative bleeding volume was measured by volum and weight after postpartum 2 h and 24 h. The serum levels of angiotensin and coagulation factors were measured by ELISA. The systolic pressures before childbirth and post partum were observed. Results ：There were not significant differences in the serum levels of Ang Ⅱ between antepartum and postpartum, in both group A and group B（P〉0.05） while this difference was significant in group C （t=7.196,P=0.009）. The same status was found in the serum levels of two coagulation factors in three groups. The hemorrhage volumes post partum 2h, 24h of group A and group B were significantly increased than that of group C （P〈 0.05）. The differences of those systolic pressures before childbirth and post partum 2h, in three groups, were not significant （P〉 0.05）. Conclusions：Misoprostol combined with oxytocin can significantly increased serum levels of angiotensin and coagulation factors when to treat effectively postpartum hemorrhage.