耳穴贴压结合西医常规疗法对再次剖宫产产后出血的影响

Efficacy of auricular acupressure combined with drugs in parturient woman with postpartum hemorrhage after secondary cesarean section

目的 观察耳穴贴压结合西医常规疗法对再次剖宫产产后出血的影响。方法 将符合入选标准的75例再次剖宫产产后出血患者，按随机数字表法分为3组，每组25例。对照组在胎儿取出前3 min舌下含服卡前列甲酯栓，胎儿取出后给予缩宫素；西药联合组在对照组基础上宫体注射卡前列素氨丁三醇；耳穴贴压组在西药联合组基础上给予耳穴贴压。比较产后2、24 h出血量，记录产后1、3、5 d宫底高度，观察泌乳始动时间和产后48 h泌乳量评分。结果 西药联合组、耳穴贴压组出血量，产后2 h[（152.3±31.1）ml、（144.7±35.6）ml比（240.4±52.5）ml，F＝42.475]、产后24 h[（326.7±80.2）ml、（266.5±62.3）ml比（374.9±74.6）ml，F＝13.923]少于对照组（P＜0.01）。西药联合组、耳穴贴压组宫底高度，产后1 d[（12.6±1.5）cm、（11.4±1.7）cm比（13.7±1.9）cm，F＝11.241]、3 d[（10.8±1.6）cm、（9.5±1.3）cm比（11.7±1.6）cm，F＝13.706]、5 d[（9.5±1.8）cm、（8.4±1.5）cm比（10.5±1.4）cm，F＝10.660]低于对照组（P＜0.01）。西药联合组、耳穴贴压组泌乳始动时间[（30.44±3.64）h、（26.36±3.95）h比（34.84±6.02）h，F＝20.736]早于对照组（P＜0.05），产后48 h泌乳量评分[（1.84±0.75）分、（2.12±0.74）分比（1.36±0.81）分，F＝9.040]高于对照组（P＜0.01）。结论 耳穴贴压结合西医常规疗法可减少再次剖宫产产后出血患者的出血量，促进子宫复旧，改善产后泌乳功能。

Objective To investigate the efficacy of auricular acupressure combined with drugs in parturient woman with postpartum hemorrhage after secondary cesarean section. Methods A total of 75 parturient women with postpartum hemorrhage after secondary cesarean section,selected from January 2015 to April 2017,were randomly divided into 3 groups. Control group was given intrauterine injection of oxytocin 20 IU and intravenous infusion of oxytocin 20 IU, as well as sublingual carboprost 1 mg; combined group was given intrauterine injection of hemabate 250 μg on the basis of control group; auricular group was treated with comprehensive therapy （auricular point sticking on the basis of combined group）. Postpartum 2 h, 24 h bleeding, postpartum 1 d, 3 d, 5 d height of fundus of uterus were recorded, and the initial time of lactation and postpartum 48 h lactation amount scores were observed. Results Postpartum 2 h, 24 h bleeding in combined group （152.3 ± 31.1 ml, 326.7 ± 80.2 ml） and auricular group （144.7 ± 35.6 ml, 266.5 ± 62.3 ml） were significantly less than those in control group （240.4 ± 52.5 ml, 374.9 ± 74.6 ml, P〈0.05）. There were no statistically significant in postpartum 2 h bleeding between combined group and auricular group （P〉0.05）, and the postpartum 24 h hemorrhage in auricular group were significantly less than the combined group （P〈0.05）. Postpartum 1 d, 3 d, 5 d height of fundus of uterus in combined group （12.6 ± 1.5 cm, 10.8 ± 1.6 cm, 9.5 ± 1.8 cm） and auricular group （11.4 ± 1.7 cm, 9.5 ± 1.3 cm, 8.4 ± 1.5 cm） were significantly lower than those in control group （13.7 ± 1.9 cm,11.7 ± 1.6 cm, 10.5 ± 1.4 cm, P〈0.05）, which in auricular group were significantly lower than those in combined group （P〈0.05）. The initial time of lactation in combined group （30.44 ± 3.64） h, and auricular group （26.36 ± 3.95） h were significantly less than those in control group （34.84 ± 6.02） h, （P〈0.05）, which in auricular group were significantly less than in combined group （P〈0.05）; the postpartum 48 h lactation amount scores in combined group （1.84 ± 0.75） and auricular group （2.12 ± 0.74） were significantly higher than those in control group （1.36 ± 0.81）, （P〈0.05）, which in auricular group were significantly higher than those in combined group （P〈0.05）. Conclusions Comprehensive therapy could reduce postpartum hemorrhage, promote uterine involution and improve postpartum lactation in parturient woman with postpartum hemorrhage after secondary cesarean section.