米索前列醇联合子宫动脉下行支结扎治疗宫缩乏力性产后出血的效果观察

Clinical observation of uterine artery ligation combined with misoprostol in treatment of postpartum hemorrhage caused by uterine inertia

目的：探讨米索前列醇联合子宫动脉下行支结扎治疗宫缩乏力性产后出血的疗效及产后恢复情况。方法选取124例宫缩乏力性产后出血患者，随机数字表法分为对照组、米索前列醇治疗组（A 组）、子宫动脉下行支结扎治疗组（B 组）、子宫动脉下行支结扎联合米索前列醇治疗组（C 组）；观察术后2 h、术后24 h 的出血量、产后恢复情况，检测血常规、血生化指标的变化。结果A、B、C 组24 h 出血量、持续出血（2～24 h）量和产褥病率均低于对照组；产后24 h 时，A、B、C 组的红细胞计数（RBC）、血红蛋白测定（HB）、红细胞比容（HCT）、前列腺素 E2（PGE2）、PGF2α含量均高于对照组，血清中抗利尿激素、肾素、血管紧张素 II、醛固酮、6-keto-PGF1α的含量均低于对照组；C 组的 RBC、HB、HTC、PGE2、PGF2α含量均高于 A、B 组，血清中抗利尿激素、肾素、血管紧张素 II、醛固酮、6-keto-PGF1α的含量均低于 A、B 组；三组间恶露时间和产后月经量，产后月经周期的差异无统计学意义（P ＞0．05）。结论米索前列醇联合子宫动脉下行支结扎能够更为有效地减少宫缩乏力性产后出血患者的出血量，同时调节前列腺素含量、抑制肾素－血管紧张素－醛固酮系统的激活。

Objective To study the curative effect and postpartum recovery of uterine artery ligation combined with misoprostol in treat-ment of postpartum hemorrhage caused by uterine inertia.Methods A hundred and twenty-four cases of patients with postpartum hem-orrhage caused by uterine inertia were randomized into control group,misoprostol treatment group（group A）,uterine artery ligation group（group B）and uterine artery ligation combined with misoprostol treatment group（group C）.Blood loss 2 h and 24 h after surgery and postpartum recovery of patients in two groups were observed,and the changes in blood routine and blood biochemical indexes were determined.Results 24 h blood loss,（2 ~24 h）continued bleeding volume and puerperal morbidity of group A,B,and C were lower than control group;24h after labor,RBC,HB,HTC,PGE2 ,PGF2αof group A,B,and C were significantly higher than control group,while serum vasopressin,renin,angiotensin II,aldosterone,6-keto-PGF1αwere significantly lower than control group.RBC,HB,HTC,PGE2 , PGF2αof group C were significantly higher than group A and B,while serum vasopressin,renin,angiotensin II,aldosterone,6-keto-PGF1αof group C were significantly lower than group A and B.Menstruation and postpartum lochia time,postpartum menstrual cycle among the three groups were not significantly different（P 〉0.05）.Conclusions Misoprostol combined with uterine artery ligation can more effectively reduce blood loss of patients with postpartum hemorrhage caused by uterine inertia,meanwhile regulate prostaglandin content,and inhibit the activation of renin-angiotensin-aldosterone system.