卡前列素氨丁三醇注射液联合低位 B-Lynch缝合术治疗难治性前置胎盘产后出血的临床疗效及安全性评价

Evaluation of clinical efficacy and safety of carboprost tromethamine injection combined with low B -Lynch suture for intractable postpartum hemorrhage placenta previa

目的：探讨卡前列素氨丁三醇注射液联合低位 B-Lynch 缝合术治疗难治性前置胎盘产后出血的临床疗效及安全性。方法将125例难治性前置胎盘产后出血患者按照治疗方法分为对照组（n ＝62）与观察组（n ＝63），对照组采用给予缩宫素，并于胎盘剥离面行“8”字间断缝合术；观察组则采用卡前列素氨丁三醇注射液联合低位 B-Lynch 缝合术。比较两组临床疗效、术中出血量、止血时间、术后2 h 出血量、术后24 h出血量、输血率及治疗前后性激素指标水平。结果（1）经治疗，对照组临床总有效率为77．42％（48／62），观察组为95．24％（60／63），两组疗效差异有统计学意义（P ＜0．05）；（2）观察组术中出血量、止血时间、术后2 h 出血量、术后24 h 出血量及输血率分别为（1608．37±43．01）mL、（8．89±1．09）min、（101．18±8．73）mL、（221．17±20．58）mL 及4．76％，均显著优于对照组[分别为（1992．28±55．62）mL、（12．83±1．77）min、（145．49±12．19）mL、（255．54±23．30）mL 及16．13％]（t ＝4．559、5．128、3．928、3．382，χ2＝5．559，均 P ＜0．05）；（3）两组治疗前后性激素指标（E2、FSH 及 LH）水平差异均无统计学意义（P ＞0．05），且两组治疗后上述指标水平差异也均无统计学意义（P ＞0．05）；（4）两组治疗过程中，肝肾功能均正常，对照组患者中3例出现恶心呕吐症状，观察组有2例出现恶心呕吐。结论卡前列素氨丁三醇注射液联合低位 B-Lynch 缝合术治疗 PPH 疗效显著，出血量小，安全性高，应加以推广。

Objective To investigate clinical efficacy and safety of carboprost tromethamine injection combined with low B -Lynch suture for intractable postpartum hemorrhage placenta previa.Methods 125 cases of intractable postpartum hemorrhage placenta previa were divided into two groups according to treatment（n =62）with the observation group（n =63）,the control group was administered oxytocin,and the line in the placental separation surface ＆quot;8 ＆quot;interrupted suture;the observation group was used carboprost tromethamine injection combined with low B -Lynch suture.Clinical efficacy,blood loss,bleeding,postoperative bleeding 2h,24h after blood loss,transfusion rate and index sex hormone levels were compared before and after treatment.Results （1）After treatment,total effec-tive rate of the control group and observation group was 77.42%（48 /62）and 95.24%（60 /63）respectively.There was a statistically significant difference between the two groups（P 〈0.05）;（2）Blood loss,bleeding time,2h after blood loss,blood loss and transfusion rate after 24h in the observation group were （1 608.37 ±43.01）mL,（8.89 ± 1.09）min,（101.18 ±8.73）mL,（221.17 ±20.58）mL and 4.76%,respectively,which were significantly lower than those of the control group [（1 992.28 ±55.62）mL,（12.83 ±1.77）min,（145.49 ±12.19）mL,（255.54 ± 23.30）mL and 16.13%]（t =4.559,5.128,3.928,3.382,χ2 =5.559,all P 〈0.05）;（3）before and after treatment indicator hormone（E2 ,FSH and LH）levels were not significantly different（P 〉0.05）,and after treatment,the index level differences were not statistically significant（P 〉0.05）;（4）the two groups during treatment,liver and kidney functions were normal,three cases of the control group and two cases of the observation group occured nausea and vomiting.Conclusion Carboprost tromethamine injection combined with low B -Lynch suture has significant effect, a small amount of bleeding,high security for intractable postpartum hemorrhage placenta previa,which should be promoted.