欣母沛对宫缩乏力性产后出血的预防作用观察

Observation on prevention effect of hemabate on postpartum hemorrhage caused by uterine inertia

目的：探讨欣母沛对宫缩乏力性产后出血的预防效果。方法：选取2015年5月～2016年5月收治的200例单胎足月分娩产妇为研究对象，依据分娩方式分为阴道分娩、剖宫产各100例，依据用药方式，将各组产妇分为欣母沛组和缩宫素组各50例；欣母沛组于胎儿娩出后给予欣母沛250μg深部肌肉注射，根据病情需要调整注射间隔和剂量，最大不超过2mg，缩宫素组于胎儿娩出后给予缩宫素10U入壶，同时缩宫素10U入0．9％氯化钠500mL静脉滴注至产后2h；观察各组产时、产后2h、产后24h出血量，抽取分娩前及分娩后24h肘静脉血3mL，全自动血细胞分析仪测定各组24h血红蛋白下降值，凝血检测仪检测产前、产后24h凝血功能指标变化，观察各组血压、心率变化。结果：阴道分娩和剖宫产产妇欣母沛组在产时、产后2h、产后24h出血量均少于缩宫素组，差异有统计学意义（P〈0．05）；阴道分娩和剖宫产产妇欣母沛组分娩后24h血红蛋白下降值分别为（13．1±6．8）、（13．2±7．1）g／L，低于缩宫素组[（21．6±4．9）、（27．4±4．3）g／L]，差异有统计学意义（P〈0．05）；产后各组24h凝血功能指标无明显变化，差异无统计学意义（P〉0．05）；用药后各组心率、血压与用药前无明显变化，两组比较无统计学意义（P〉0．05）。结论：欣母沛可有效预防宫缩乏力引起的产后出血，明显优于缩宫素，在阴道分娩、剖宫产均是安全有效的，值得临床推广。

Objective： To explore the prevention effect of hemabate on postpartum hemorrhage caused by uterine iner- tia. Methods： A total of 200 puerpera with single full--term delivery who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into vaginal delivery group and cesarean section with 100 cases in each group according to the delivery modes. According to the medication methods, each group was divided into hemabate group and oxyto- cin with 50 cases in each group. The puerpera in the hemabate group were given deep intramuscular injection of hemabate（250 μg）after fetus delivery, and the injection interval and dosage were adjusted according to the condition, with the maximum dose not exceeding than 2 mg. The puerpera in the oxytocin group were given oxytocin （10 U） and 0.9% NaC1 after fetus deliv- ery, ivdrip, for 2 h. The amount of bleeding during delivery, 2 h and 24 h after delivery in each group was observed. A volume of 3 mL elbow venous blood before delivery and 24 h after delivery was extracted. The full automatic blood cell analyzer was used to detect 24h hemoglobin decrease value in each group. The coagulation detector was used to detect the change of coagula- tion function index （PT, APTT, and FIB） before delivery and 24 h after delivery. The blood pressure and heart rate in each group were observed. Results.. The amount of bleeding during delivery, 2 h and 24 h after delivery in hemabate group was sig- nificantly less than that in oxytocin group （P〈0.05）. The hemoglobin decrease values 24 h after delivery in hemabate group with vaginal delivery and cesarean section [（13.1 ± 6.8） g/L and （13.2 ± 7.1 ） g/L] were significantly lower than those in oxyto- cin group [（21.6±4.9） g/L and （27.4±4.3） g/L]（P〈0.05）. The coagulation function indicators 24 h after delivery in each group were not significantly changed （P〉0.05）. The heart rate and blood pressure after medication in each group were not sig- nificantly different from those before medication, and the comparison between the two groups was not statistically significant （P〉0.05）. Conclusions： Hemabate can effective prevent the postpartum hemorrhage caused by uterine inertia, significantly superior to that by oxytocin, and is safe and effective in application of vaginal delivery and cesarean section; therefore, it de- serves to be widely recommended in the clinic.