卡贝缩宫素/卡前列素氨丁三醇联合地塞米松防治高危妊娠产妇产后出血的临床观察

Clinical Observation of Carbetocin/Hemabate Combined with Dexamethasone for Postpartum Hemorrhage in High-risk Pregnancy Puerperant

目的：观察卡贝缩宫素／卡前列素氨丁三醇联合地塞米松防治高危妊娠产妇产后出血的临床疗效和安全性方法：176例有高危因素的经阴道分娩或剖宫产产妇按随机数字表法分为观察组（91例）和对照组（85例）。两组产妇均给予地塞米松10mg加入10％葡萄糖注射液20ml中静脉推注，催产素20IU静脉推注或臂部肌肉注射后，观察组产妇给予卡贝缩宫素100μg单次静脉推注；对照组产妇给予卡前列素氨丁三醇250μg，剖宫产产妇单次子宫体肌肉注射，阴道分娩产妇在胎儿娩出后立即经臀部肌肉注射。观察两组产妇的临床疗效，产前、产中给药前及给药30min后收缩压（SBP）、舒张压（DBP）、心率（HR）的变化．产后2h内和2～24h的出血例数和平均出血量，产后2h内子宫张力变化，产后24h内是否需要额外干预治疗及不良反应发生情况．结果：两组产妇总有效率、产后2h内子宫张力变化比较差异均无统计学意义（P〉0．05）；给药30min后两组产妇SBP、DBP、HR均显著高于产前及产中给药前，两组产妇产后2～24h平均出血量均显著低于同组2h内．观察组产妇不良反应发生率显著低于对照组产妇，差异均有统计学意义（P〈0．05）。两组产妇产后24h内均无需要额外干预治疗的情况发生．结论：卡贝缩宫素／卡前列素氨丁三醇联合地塞米松治疗高危妊娠产妇产后出血均具有显著疗效，但卡贝缩宫素联合地塞米松的安全性更好。

OBJECTIVE： To observe clinical efficacy and safety of carbetocin/hemabate combined with dexamethasone for postpartum hemorrhage in high-risk pregnancy puerperant. METHODS： 176 pregnant women adopting vaginal delivery and cesarean section were divided into observation group （91cases） and control group （85cases） by random number method. Both groups were given dexamethasone 10 mg added into 10% Glucose injection 20 ml intravenously, and intravenous injection or arm intramuscular injection of oxytocin 20 IU. Observation group additionally received single intravenous injection of carbetocin 100 /ag; control group additionally received hemabate 250 pg, and pregnant underwent cesarean section was given single intramuscular injection while pregnant underwent vaginal delivery was given arm intramuscular injection once fetal disengagement. Clinical efficacy, the changes of SBP, DBP and HR before and 30 min after medication before and during births were observed in 2 groups; the case number of bleeding and the average amount of bleeding in 2 h and 2-24 h after postpartum, changes of postpartum uterine tension in 2 h, additional postpartum interventions within 24 h and the occurrence of ADR were all observed in 2 groups. RESULTS： There was no significant difference in total effective rate and 2 h postpartum uterine tension between 2 group （P〉0.05）; the levels of SBP, DBP and HR in 2 groups 30 min after medication were significantly higher than before birth and before medication during birth; the average amount of hemorrhage in 2-24 h after postpartum were significantly lower than that in 2 h; the incidence of ad- verse drug reactions in observation group was significantly lower than in control group; there were statistical significance （P〈 0.05）; there were no additional intervention cases within 24 h after postpartum. CONCLUSIONS： Carbetocin/hemabate combined with dexamethasone is significantly effective for postpartum hemorrhage in high-risk pregnancy puerperant, but carbetocin combined with dexamethasone is safer than hemabate.