中央性前置胎盘剖宫产中欣母沛不同应用时机临床研究

Different Timing of Hemabate Application on Caesarean Section of Central Placenta Previa

目的观察并比较欣母沛结合相应护理方案在中央性前置胎盘剖宫产中不同应用时机的临床疗效。方法选取中央性前置胎盘产妇90例,随机分为对照组、欣母沛A组和欣母沛B组,各30例。对照组于胎儿前肩娩出后给予产妇缩宫素20 U子宫肌肉注射联合缩宫素20 U静脉滴注,发生产后出血时采用按摩子宫、宫腔填纱、子宫动脉结扎等方式止血;欣母沛A组在常规治疗基础上,在发生产后出血时应用欣母沛250μg子宫肌肉或前臂三角肌注射,15 min后出血仍无明显控制重复注射。欣母沛B组于胎儿前肩娩出后常规静脉滴注缩宫素同时立即在产妇子宫肌肉或前臂三角肌肉注射欣母沛250μg。3组产妇均接受相应的产科护理方案。观察3组产妇治疗后临床疗效及产后24 h内出血总量,记录治疗过程中药物不良反应的发生情况。结果欣母沛B组以及欣母沛A组防治产后出血的总有效率高于对照组,差异有统计学意义(P<0.05),且欣母沛B组效果优于欣母沛A组,差异有统计学意义(P<0.05)。而欣母沛B组及欣母沛A组在术中、术后2 h、24 h内总出血量均低于对照组,差异有统计学意义(P<0.05)。欣母沛B组在术中、术后2 h、24 h内总出血量均低于欣母沛A组,差异有统计学意义(P<0.05)。对照组、欣母沛A组和欣母沛B组治疗中不良反应发生情况相似,且未出现严重的不良反应,不影响治疗。结论预防性应用欣母沛结合相应护理可更有效防治产妇术中及产后出血,临床疗效显著,不良反应较少,值得临床推广。

Objective To observe and compare the clinical efficacy of different timing of hemabate combined with appropriate nursing care program on caesarean section of central placenta previa. Methods 90 pregnant women with central placenta previa were randomly divided into the control group, the hemabate group A and the hemabate group B, 30 cases in each group. The control group received maternal uterine oxytocin 20 U intramuscular combined with oxytocin 20 U intravenous infusion after the baby＇s front shoulder was de- livered, massaging the uterus, uterine filling yarn, uterine artery ligation and other ways to stop bleeding; on the basis of the conventional treatment group, the hemabate group A received hemabate 250 μg uterine muscle or forearm deltoid injection based on the occurrence of postpartum hemorrhage, if after 15 min there was still no significant bleeding control, repeated the injections; the hemabate group B received conventional intravenous infusion of oxytocin in the maternal womb and immediately forearm deltoid muscle or intramuscular hemabate 250 ~g after the baby＇s front shoulder was delivered. 3 groups were treated with appropriate obstetric care program, the clini- cal efficacy and 24 h postpartum hemorrhage in the 3 groups were observed, and the adverse drug reactions occurred during the treat- ment were recorded. Results The total effective rates of postpartum hemorrhage in hemabate group B and hemabate group A were higher than the control group, the difference was statistically significant（ P 〈 0. 05）, and hemabate group B was better than hemabate group A, the difference was statistically significant（P 〈 0. 05）. The overall bleeding during operation and 2 h, 24 h postoperative in hemabate group B and hemabate group A were lower than the control group, the difference was statistically significant（ P 〈 0.05）, and hemabate group B was better than hemabate group A, the difference was statistically significant（ P 〈 0.05）. The adverse events in the 3 groups were similar, and no serious adverse reactions that affected the treatment occurred. Conclusion Prophylactic application of hema- bate combined with corresponding maternal nursing can more effectively prevent intraoperative and postpartum hemorrhage, has significant clinical efficacy with fewer adverse reactions, which is worthy of clinical promotion.