腹腔镜子宫肌瘤剔除术中缩宫素不同用药方法的止血疗效分析

Study on hemostatic effect of different methods of oxytocin in laparoscopic myomectomy

目的 探讨腹腔镜子宫肌瘤剔除术中以不同用药途径应用缩宫素的止血疗效，阐明缩宫素在腹腔镜子宫肌瘤剔除术中的最佳给药方式。方法 选取我院2016年1月至2017年7月因子宫肌瘤行经腹腔镜肌壁间子宫肌瘤剔除手术患者90例，按不同用药方式分成A、B两组，每组45例。A组术中给予缩宫素20 U＋5%葡萄糖注射液250 ml静脉滴注，B组术中子宫肌瘤处肌壁注射缩宫素20 U。比较两组患者手术前后一般情况、术中出血量、手术时间、术中和术后不良反应和住院时间。结果 手术出血量B组为（76.5±15.8） ml，明显少于A组（99.8±20.7） ml；手术时间B组为（71.2±10.7） min，较A组（90.1±18.4） min明显缩短，两组比较差异均有统计学意义（t值分别为1.788、2.878，P均〈0.05）。用药后5、30、180 min，A组患者收缩压分别为（132.2±1.4）、（120.7±5.3）、（110.9±1.8） mmHg，舒张压分别为（80.9±12.5）、（71.4±12.6）、（70.1±2.8） mmHg；B组患者收缩压分别为（140.4±11.1）、（131.2±4.5）、（121.4±11.2） mmHg，舒张压分别为（93.4±8.1）、（86.4±7.1）、（81.1±1.5） mmHg，两组比较差异均有统计学意义（收缩压：F组内＝68.57，P〈0.001；F组间＝16.54，P〈0.001；F交互＝4.34，P＝0.011；舒张压：F组内＝45.16，P〈0.001；F组间＝10.79，P＝0.024；F交互＝4.16，P＝0.037）;同一用药时间，B组收缩压和舒张压均高于A组，差异均有统计学意义（P均〈0.05）。结论 腹腔镜子宫肌瘤剔除术中应用缩宫素止血，子宫肌瘤处肌壁注射方式给药可明显减少术中出血量，缩短手术时间，其效果明显优于静脉滴注的用药方式，有利于手术的开展。

Objective To examine the hemostatic effect of oxytocin in laparoscopic myomectomy, and to clarify the optimal dosage of oxytocin in laparoscopic myomectomy.Methods From January 2016 to July 2017, ninety patients with myoma of uterus who underwent laparoscopic myomectomy in Tangshan Union Medical College Hospital were divided into two groups： group A and group B, 45 cases in each group.In group A, the patients were given 20U oxytocin and 5% glucose injection 250 ml via intravenous drip, and in group B, the patients were injected with 20U oxytocin on the muscular wall of uterus myoma during operation.The preoperative, postoperative basic situation, intraoperative blood loss, operation time, intraoperative and postoperative adverse reactions and the time of hospitalization were compared between the two groups.Results The average amount of blood loss during operation in group B was （76.5±15.8） ml, significantly lower than that in group A（（99.8±20.7） ml）, and the operation time in group B was （71.2±10.7） min, shorter than that in group A （（90.1±18.4） min） The difference was statistically significant （t=1.788、2.878, P〈0.05）. At 5 minutes, 30 minutes and 180 minutes after medication, the systolic blood pressure of patients in group A was （132.2±1.4） mmHg, （120.7±5.3） mmHg, （110.9±1.8） mmHg and the diastolic blood pressure was （80.9±12.5） mmHg, （71.4±12.6）mmHg, （70.1±2.8） mmHg, while the systolic blood pressure in the group B was （140.4±11.1） mmHg, （131.2±4.5） mmHg, （121.4±11.2） mmHg and the diastolic blood pressure was （93.4±8.1） mmHg, （86.4±7.1） mmHg, （81.1±1.5） mmHg, the differences were statistically significant（systolic blood pressure： Ftime=68.57, P〈0.001; FgrouP=16.54, P〈0.001; Finteraction=4.34, P=0.011; diastolic blood pressure： Ftime=45.16, P〈0.001; FgrouP=10.79, P=0.024; F interaction=4.16, P=0.037）; at the same treatment time, the systolic blood pressure and diastolic blood pressure in group B were higher than those in group A, the differences were statistically significant （P〈0.05）.Conclusion Laparoscopic uterine myomectomy with oxytocin hemostasis, intrauterine myoma wall injection method can significantly reduce intraoperative blood loss and shorten the operation time, the effect is obviously better than intravenous drip, and it is conducive to the operation.