瘢痕子宫二次剖宫产术后卡孕栓使用疗效分析

Clinical analysis of the application of carboprost suppositories after secondary cesarean section of scar uterus

目的观察瘢痕子宫二次剖宫产术后单用缩宫素与联合应用卡孕栓在减少产后出血、促进产妇恢复、不良反应等方面的差别,为临床提供理论依据。方法选择2016年5~8月在我院产科正常足月妊娠因瘢痕子宫行二次剖宫产的115例产妇为研究对象,随机分成缩宫素组(对照组)和卡孕栓+缩宫素联用组(观察组),比较两组产妇在术中、术后2、24h的出血量,术后第一天、第二天的子宫收缩情况,术后排气、排尿时间及不良反应上的差异。结果 (1)对照组术中出血量(291.28±51.53)mL,术后2h出血量(335.66±47.30)mL,术后24h出血量(415.11±52.79)mL;观察组术中出血量(263.38±56.29)mL,术后2h出血量(300.93±58.79)mL,术后24h出血量(370.44±63.26)mL,观察组产后出血量较对照组明显减少,差异具有统计学意义(P<0.05)。(2)对照组术后第一天宫底高度脐下(0.59±0.69)cm,术后第二天宫底高度脐下(1.51±0.63)cm;观察组术后第一天宫底高度脐下(0.90±0.81)cm,术后第二天宫底高度脐下(1.97±0.72)cm,观察组术后子宫较对照组收缩更为显著(P<0.05)。对照组术后初次排气时间(34.83±5.72)h,术后24h拔除尿管后初次排尿时间(2.66±0.67)h;观察组术后初次排气时间(30.62±6.97)h,术后24h拔除尿管后初次排尿时间(2.33±0.74)h,观察组术后排气、排尿时间较对照组明显缩短,差异有统计学意义(P<0.05)。(3)两组患者术后仅少数产妇出现了以恶心、呕吐、腹泻等为主的消化道不良反应,经检验差异无统计学意义(P>0.05)。结论卡孕栓对于减少瘢痕子宫二次剖宫产产后出血、促进产妇排尿排气,效果良好,值得临床推广使用。

Objective To observe the difference between oxytocin alone and combined application of carboprost suppositories in reducing postpartum hemorrhage,promoting maternal recovery and adverse reactions after cesarean section of scar uterus,so as to provide theoretical basis for clinical practice. Methods From May to August 2016,115 parturients who underwent second cesarean section in normal term pregnancy due to scar uterus in our hospital were selected as the subjects.They were randomly divided into oxytocin group （control group） and combined group of carboprost suppository and oxytocin （observation group）.The bleeding volume of 2h and 24h in the two groups were compared between the two groups.The difference of uterine contraction,postoperative exhaust time,urination time and adverse reaction after operation on the first day and the second day after operation were compared. Results （1）The amount of bleeding in the control group was （291.28±51.53）mL,and the amount of 2h bleeding was （335.66±47.30）mL after operation,and the amount of 24h hemorrhage was （415.11±52.79）mL after operation.The amount of bleeding in the observation group was （263.38±56.29）mL,and the amount of 2H bleeding after operation was （300.93±58.79）mL,and the amount of 24h hemorrhage was （370.44±63.26）mL after operation.The amount of postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the difference was statistically significant （P 〈0.05）.（2）In the control group,the height of the uterus at the first day after the operation was （0.59±0.69）cm,and the height of the uterine fundus was （1.51±0.63）cm at second days after the operation.In the observation group,the height of the uterus at the first day after the operation was （0.90±0.81）cm,and the height of the uterine fundus was （1.97±0.72）cm at second days after the operation.The contraction of the uterus in the observation group was more significant than that in the control group （P 〈0.05）.The initial exhaust time of the control group was （34.83±5.72）h after operation,and the initial urination time was （2.66±0.67）h after the extraction of urethral catheter 24 hours after the operation.The initial exhaust time of the observation group was （30.62±6.97）h,and the initial urination time was （2.33±0.74）h after the extraction of urethral catheter 24 hours after the operation.The time of exhaust and urination in the observation group was significantly shorter than that in the control group,and the difference was statistically significant （P 〈O.05）.（3）Two groups of patients only a few puerperal women had nausea,vomiting,diarrhea and other gastrointestinal adverse reactions.There was no statistically significant difference between the two groups （P 〉0.05）. Conclusion The carboprost suppository has good effect on reducing postpartum hemorrhage after cesarean section of scar uterus and promoting urination and exhaust of parturient,and is worthy of clinical popularization and application.