益母草注射液联合卡前列素氨丁三醇预防剖宫产后出血的疗效及对患者FIB,D-二聚体水平的影响

Curative Efficacy of Yimucao Injection Combined with Carboprost Tromethamine in Preventing Cesarean Section Postpartum Hemorrhage and on FIB and D-dimer Levels

目的:探讨益母草注射液联合卡前列素氨丁三醇预防剖宫产产后出血疗效及对患者纤维蛋白原(FIB),D-二聚体(D-dimer)水平的影响。方法:140例具有产科剖宫产指征及宫缩乏力高危因素的产妇按随机数字表法随机分为对照组(n=70)和观察组(n=70)。对照组在胎儿娩出后给予卡前列素氨丁三醇子宫宫体注射,观察组在对照组的基础上联合应用益母草注射液肌肉注射。观察比较两组患者术后2,24 h出血量、产后出血发生率、药物注射后宫缩持续时间、产后子宫底下降速度、恶露持续时间、治疗前后FIB,D-dimer水平及不良反应发生情况。结果:与对照组相比,观察组术后2,24 h出血量显著减少(234.5±50.2)VS(356.2±51.5),(309.7±64.5)VS(443.3±68.6)m L,产后出血发生率明显降低(4.3%VS14.3%),药物注射后宫缩持续时间显著延长(3.43±1.03)VS(1.62±0.54)h,产后子宫底下降速度更快(1.15±0.24)VS(0.56±0.13)cm·d-1,恶露持续时间明显缩短(14.8±4.7)VS(21.5±6.2)d,FIB,D-dimer水平显著下降(3.50±0.24)VS(4.61±0.42)g·L-1,(1.21±0.23)VS(3.47±0.29)mg·L-1,比较都有统计学差异(P<0.05)。治疗过程中,未出现严重不良反应,且不良反应发生率组间比较无统计学差异(18.6%VS 21.4%)。结论:益母草注射液联合卡前列素氨丁三醇是剖宫产产后出血的一种有效预防方案,能够显著减少术后出血量,降低产后出血发生率,延长宫缩时间,促进产后恢复,改善血液高凝状态,且不良反应轻微,临床上值得进一步研究。

Objective： To investigate the curative efficacy of Yimucao injection combined with carboprost tromethamine in preventing cesarean section postpartum hemorrhage and on levels of fibrinogen （FIB） and D-dimer. Method ： One hundred and forty cases of obstetric indications for cesarean section and with high risk factors of uterine inertia were divided into 2 groups equally according to random number table： the control group （ n = 70） and the observation group （ n= 70）. After delivery of the fetus in cesarean section, the control group was treated with uterus injection of carboprost tromethamine, while the observation group was treated with intramuscular injection of Yimucao injection and uterus injection of carboprost tromethamine. Their 2, 24 h postoperative blood loss, the incidence of postpartum hemorrhage, duration of uterine contraction after the drug injection, lowering speed of uterine bottom after delivery, duration of lochia, level of FIB, D-dimer and adverse reactions were observed and compared. Result： In comparison with the control group, 2, 24 h postoperative blood loss were significantly lower （234.5 ±50.2） VS （356.2 ±51.5）, （309.7 ±64.5）. vs （443.3±68.6） mL and the incidence of postpartum hemorrhage was significantly lower （4.3% VS 14.3% ） in the observation group （both P 〈 0.05）. After the drug injection, the observation group had a significantly longer duration of uterine contraction （3.43±1.03） VS （1.62 ±0.54） h, quicker lowering speed of uterine bottom （1.15 ±0.24） VS （0.56 ±0. 13） cm·d^-1 and shorter duration of lochia （14. 8±4.7） VS （21.5±6.2） d than those in the control group （all P 〈 0.05）. And level of FIB （3.50±0.24） VS （4.61±0.42） g·L^-1, D-dimer （1.21±0.23） VS （3.47±0.29） mg · L^-1 in the observation group was respectively lower than that in the control group after the treatment （both P 〈 0.05）. During the treatment, there was no case of severe adverse reaction and no statistical difference in intergroup comparison of the incidence of adverse reactions （18.6% VS 21.4% ）. Conclusion： Therapy of Yimucao injection combined with carboprost tromethamine was effective in the prevention of cesarean section postpartum hemorrhage, and could effectively reduce postoperative blood loss, decrease the incidence of postpartum hemorrhage, lengthen duration of uterine contraction, promote postpartum recovery and mitigate high blood coagulation, with minor adverse reactions. It is worth further studies in clinic.