卡贝缩宫素预防产后出血的临床效果研究

Clinical effects of carbetocin on preventing postpartum hemorrhage

目的：探讨卡贝缩宫素静脉滴注对产后出血的防治效果。方法按照随机数字表法将2013年3月至2014年3月北京市延庆县妇幼保健院收治的有产后出血高危因素的健康足月经阴道分娩初产妇357例分为两组，胎儿娩出后，观察组予以卡贝缩宫素100mg＋0．9％氯化钠注射液100mL静脉滴注，对照组予以缩宫素20IU＋5％葡萄糖注射液500mL静脉滴注。记录两组胎盘娩出时和产后2h、24h的出血量以及产后的出血情况，并对数据进行分析。结果观察组第三产程时间（12．56±3．38）min少于对照组（17．72±2．64）min，差异有统计学意义（t＝6．083，P＜0．05）。观察组胎儿娩出时、产后2h、产后24h的出血量少于对照组，差异均有统计学意义（t值分别为3．685、5．382、6．735，均P＜0．05）。观察组产后出血率为13．97％（25／179），对照组为23．03％（41／178），观察组产后出血率低于对照组，差异有统计学意义（χ2＝4．869，P＝0．027）。两组产后均发生不同程度的呕吐、恶心、潮红以及低血压，两组的不良反应发生率差异均无统计学意义（均P＞0．05）。结论卡贝缩宫素静脉滴注可有效预防产后出血，具有简单、方便和副作用小的特点，有重要的临床推广价值。

Objective To explore prevention effect of carbetocin given by intravenous drip for postpartum hemorrhage.Methods Totally 357 healthy transvaginal delivery primipara with high risk factors of postpartum hemorrhage admitted in Yanqing Maternal and Children Health-Care Center from March 2013 to March 2014 were divided into two groups according to random number table.In observation group 100mg carbetocin combined with 100mL of 0.9%sodium chloride was given by intravenous drip after fetus delivery, and in control group 20IU oxytocin combined with 500mL of glucose was given by intravenous drip.The amounts of bleeding in placental delivery, 2h and 24h after delivery were recorded in two groups.Results The third stage labor time in the observation group （12.56 ±3.38min） was significantly less than that in the control group （17.72 ±2.64min） （t=6.083, P〈0.05）.The amounts of bleeding in placental delivery, 2h and 24h after delivery were less in the observation group than in the control group, and the differences were statistically significant （ t value was 3.685, 5.382 and 6.735, respectively, all P〈0.05）.The incidence of postpartum hemorrhage in the observation group was 13.97%（25/179）, which was less than 23.03% in the control group （41/178）, and the difference was statistically significant （χ2 =4.869, P =0.027 ）.There were adverse reactions with different degree in two groups including vomiting, nausea, flushing and hypotension, but the difference was not statistically significant （all P〉0.05）.Conclusion Carbetocin given by intravenous injection can effectively prevent postpartum hemorrhage, which is simple and convenient with mild side effect.It has important clinical value.