卡前列素氨丁三醇注射液与B-Lynch缝合术治疗剖宫产术中子宫出血的效果比较

Comparison of Hemabate and B-Lynch Suture for Intraoperative Uterine Hemorrhage

目的：比较卡前列素氨丁三醇注射液（欣母沛）与子宫 B-Lynch 缝合术治疗剖宫产术中因宫缩乏力所致大出血的临床疗效。方法将40例行剖宫产术中因宫缩乏力所致产后出血的患者按随机数字表法分为2组，每组20例。2组患者均在常规处理后子宫仍未收缩且有大量活动性出血时，欣母沛组给予欣母沛250μg 子宫体注射，间隔15-30 min 可重复使用；B-Lynch 组采取子宫 B-Lynch 缝合术止血。对2组疗效、止血时间、产后出血量及子宫复旧效果进行比较。结果欣母沛组有效率为100．0％，止血时间为（39．6±7．2）min，产后出血量为（1065．1±12．7）mL；B-Lynch 组有效率为80．0％，止血时间为（67．3±15．7）min，产后出血量为（1334．5±13．6）mL。欣母沛组患者有效率高于 B-Lynch 组、止血时间明显短于 B-Lynch 组、产后出血量明显少于 B-Lynch 组（均 P ＜0．05）。所有患者术后均随访2个月，欣母沛组子宫均恢复良好，B-Lynch 组3例患者子宫复旧不良。结论欣母沛治疗剖宫产术中产后出血临床效果显著，能有效地缩短止血时间及减少出血量，无明显不良反应。当术中发现出血倾向尽早使用该药疗效更好。

Objective To compare the clinical effects of carboprost tromethamine injection （hemabate）and B-Lynch suture on uterine inertia-induced massive hemorrhage during cesarean delivery.Methods After conventional treatment,40 patients with uterine inertia-induced postpartum hemorrhage were randomly assigned to receive either uterine body injection of 250 μg hema-bate（repetition intervals 15-30 minutes）or B-Lynch suture when patients had massive active hemorrhage with no uterine contraction.Curative effect,time to hemostasis,bleeding volume and uterine involution were compared between the two groups.Results Compared with B-Lynch su-ture,hemabate injection increased the effective rate（100.0% vs 80.0%）,shortened the time to hemostasis[（39.6 ± 7.2）minutes vs （67.3 ± 15.7）minutes],and reduced postpartum bleeding volume[（1 065.1±12.7）mL vs （1 334.5±13.6）mL]（P 〈0.05）.After follow-up for 2 months, the uterus recovered well in all patients treated with hemabate,but poor uterine involution was found in 3 patients treated with B-Lynch suture.Conclusion Hemabate treatment can effectively shorten the time to hemostasis and reduce the volume of hemorrhage with no obvious adverse re-actions in patients with postpartum hemorrhage.Therefore,hemabate should be used as soon as possible when patients have bleeding tendency during cesarean delivery.