阿卡前列素氨丁三醇联合B-Lynch缝合治疗剖宫产产后大出血效果观察

Carboprost tromethamine combined with B-Lynch suture for postpartum hemorrhage

目的探讨卡前列素氨丁三醇联合B-Lynch缝合治疗剖宫产产后大出血的临床效果。方法选择2012年1月至2015年6月本院收治的剖宫产术后大出血患者80例，按照随机数字法分为两组，各40例，对照组行B-Lynch缝合，观察组使用卡前列素氨丁三醇宫体注射联合B-Lynch缝合，比较两组手术及术后恢复情况、产后出血量、术后24h血小板计数及D-二聚体水平，并统计治疗期间发生的不良反应。结果观察组患者手术时间为（52．8±11．7）min，短于对照组的（60．3±13．4）min（P〈0．05）。术后恶露持续时间为（15．6±2.8）d，短于对照组的（25．6±3．7）d（P〈0．05），月经恢复时间为（5．3±1．2）月，早于对照组的（6．7±1．8）月（P〈0．05），观察组产后2h出血量为（86．5±15．2）ml及产后24h出血量为（70．8±11．7）ml，均显著少于对照组的（100．8±19．1）ml和（150．3±13．3）ml（均P〈0．05）。术后24h观察组血小板计数为（158．6±25．7）×109／L，高于对照组的（89．5±11．1）×109／L（P〈0．05）。D-二聚体水平为（0．6±0．1）μg／ml，低于对照组的（3．1±O．5）la,g／ml（P〈0．05）。观察组发生恶心呕吐和血压升高的比例显著低于对照组（均P〈0．05）。结论卡前列素氨丁三醇宫体注射联合B-Lynch缝合能有效减少剖宫产术后大出血量，减少术中不良反应，促进患者术后康复。

Objective To investigate the effect of carboprost tromethamine combined with B-Lynch suture for postpartum hemorrhage. Methods 80 patients with hemorrhage after cesarean section treated at our hospital from January, 2012 to June, 2015 were selected and were randomly divided into a control group and an observation group, 40 for each group. The control group were treated by B-Lynch suture and the observation group were treated with carboprost tromethamine and B-Lynch suture. The surgical and postoperative recovery conditions, postpartum hemorrhage, postoperative 24 hours platelet count, and D-dimer level were compared between these two groups. The incidence of adverse reactions during treatment was calculated. Results The operation time, the duration of postoperative lochia, the menstruation recovery time, the bleeding volume 2 hours delivery, the bleeding volume 24 hours after delivery, the platelet count 24 hours after the operation, and the D-dimer level were （ 52.8±11.7 ） min, （ 15.6±2.8 ） d, （ 5.3±1.2 ） months, （ 86.5±15.2 ） ml, （ 70.8±11.7 ） ml, （ 158.6±25.7 ）×10^9/L, and （ 0.6±0.1 ） μg/ml in the observation group and were （ 60.3±13.4 ） min, （ 25.6±3.7 ） d, （ 6.7±1.8 ） months, （ 100.8±19.1 ） ml, （ 89.5±11.1 ）×10^9/L, and （ 3.1±0.5 ） μg/ml in the control group （ all P 〈 0.05 ） . The incidences of nausea and vomiting and high blood pressure were significantly lower in the observation group than in the control group （all P 〈 0.05）. Conclusions Carboprost tromethamine combined with B-Lynch suture can effectively reduce the bleeding volume after cesarean section and intra-operative adverse reactions, so it can promote the patients＇ postoperative rehabilitation.