卡前列素氨丁三醇在凶险性前置胎盘产后大出血患者中的应用价值

Application value of Hemabate in postpartum hemorrhage of patients with dangerous placenta previa

目的研究卡前列素氨丁三醇(欣母沛)在凶险性前置胎盘产后大出血患者中的应用价值,为临床上有效防治凶险性前置胎盘产后大出血提供参考。方法回顾性分析2012年1月~2014年12月于贵州医科大学附属医院产科住院治疗经剖宫产终止妊娠患者48例凶险性前置胎盘患者的临床资料,根据止血方式的不同将其分为对照组(23例)和研究组(25例)。对照组患者胎儿娩出断脐后于子宫体注射缩宫素20 U及静脉滴注缩宫素20 U;研究组患者于胎儿娩出断脐后于子宫体注射欣母沛500μg。观察及比较两组患者产后2、24 h出血量及子宫切除发生率;观察研究组不良反应发生情况。结果研究组3例患者发生产后大出血,对照组10例患者发生产后大出血,研究组产后大出血发生率(12.0%)明显低于对照组(43.5%),差异有统计学意义(P<0.05)。研究组产后2、24 h出血量[(435.7±60.1)、(499.6±87.6)mL]明显少于对照组[(536.1±42.3)、(685.3±93.5)mLl,差异均有统计学意义(P<0.05)。对照组3例患者因出血无法控制行子宫切除,研究组无一例行子宫切除。研究组治疗后主要不良反应为恶心(16%)、呕吐(12%)、心率增快(8%)及血压升高(4%)。结论欣母沛可有效减少凶险性前置胎盘剖宫产后出血量,降低子宫切除率,且不良反应少,值得作为防治凶险性前置胎盘产后出血的一线用药。

Objective To study the application value of Hemabate in postpartum hemorrhage of patients with dangerous placenta previa, and provide a reference for effective prevention and treatment of postpartum hemorrhage of patients with dangerous placenta prevla. Methods Clinical data of 48 patients with dangerous placenta previa from January 2012 to December 2014 given caesarean section in the Department of Obstetrics and Gynecology, the Affiliated Hospi- tal of Guiyang Medical College were retrospectively analyzed, and they were divided into two groups according to the different methods of hcmostasis, 23 patients of the control group were given the oxytocin 20 U injection in uterine body and intravenous drip of oxytocin 20U after the fetal delivery, and 25 patients of the observation group were given the Hemabate 500 p^g injection in uterine body after cord clamping. The amount of bleeding 2, 24 h after delivery and in- cidence of hysterectomy observed and compared; incidence of adverse reaction of the observation group was observed. Results 3 cases with postpartum hemorrhage of the observation group, and 10 cases with postpartum hemorrhage of the control group, incidence of postpartum hemorrhage of the postpartum hemorrhage in the observation group （12.0%）was lower than that of the control group （43.5%）, the difference was statistically significant （P 〈 0.05）. The amount of bleed- ing in the observation group at 2, 24 h after delivery [（435.7＋60.1）, （499.6＋87.6） mL] were less than those of the control group [（536.1_＋42.3）, （685.3＋93.5） mL], the differences were statistically significant（P 〈 0.05）. 3 cases were hysterecto- my because of the out-of-control postpartum hemorrhage, but none of the observation group underwent hysterectomy. Adverse reaction after treatment of the observation group were nausea （16%）, emesis （12%）, heart rate increase （8%） and elevation of blood pressure （4%）. Conclusion Hemabate can efficiently reduce the amount of bleeding of patients with dangerous placenta previa after delivery, reduce the incidence of hysterectomy, and less adverse reaction, it is worthy of clinical popularization and application.