间隔注射垂体后叶素联合套扎止血法在腹腔镜下子宫肌瘤切除术中的应用效果及对循环系统的影响

The effect of interstitial injection of pituitrin combined with hemostasis in laparoscopic hysteromyomectomy and its effect on the circulatory system

目的观察间隔注射垂体后叶素联合套扎止血法在腹腔镜下子宫肌瘤切除术中的应用效果,同时评价该方法对患者循环系统的影响。方法采用前瞻性随机双盲对照法,选择惠州市妇幼保健计划生育服务中心妇产科于2015年1月至2017年12月收治的100例子宫肌瘤患者作为研究对象,按照随机平行分组法将其随机分为两组,对照组(n=50)一次性注射垂体后叶素+套扎止血,观察组(n=50)间隔注射垂体后叶素+套扎止血,对比两组患者的各项手术指标(手术时间、术中出血量、术后引流量、肛门排气时间)以及药物注射后各时间段收缩压(SBP)、舒张压(DBP)及心率(HR),统计两组患者治疗期间的不良反应。结果观察组患者的术中出血量(60.3±5.9 ml)少于对照组(72.3±6.3),差异有显著性(P<0.05),但两组患者的手术时间、术后引流量、肛门排气时间比较差异均无统计学意义(P>0.05);两组患者注射药物后5 min、10 min、15 min后的SBP、DBP、HR与注射药物前比较差异均具有统计学意义(P<0.05),但注射药物后30 min后与注射药物前比较差异均无统计学意义(P>0.05),对照组患者注射药物后5 min、10min、15 min后的SBP、DBP、HR均低于观察组(P<0.05);观察组组患者治疗期间不良反应(血压波动、心率波动、切口血肿、延迟愈合、发热、感染)总发生率(28.0%)与对照组(34.0%)比较,差异无统计学意义(P>0.05)。结论与一次性注射垂体后叶素相比,间隔注射垂体后叶素在腹腔镜下子宫肌瘤切除术中能够降低术中出血量,且对循环系统的影响更轻微,手术效果相同,建议临床推广应用。

Objective To observe the interval of the injection of pituitrin combined ligation hemostasis method in the application of laparoscopic hysteromyoma resection effect,and the effect of evaluation of this method on patients with circulatory system. Methods From January2015 to December 2017,100 cases of uterine fibroids were selected in the study,and according to the randomized grouping method,they were randomly divided into two groups,including the control group（ n = 50） performed intraperitoneal injection of pituitrin plus ligation of bleeding and the observation group（ n = 50） given interval injection of pituitrin plus ligation of bleeding. The operation time,intraoperative bleeding volume,postoperative drainage,exhaust time and the systolic blood pressure（ SBP）,diastolic blood pressure（ DBP） and heart rate（ HR） after drug injection in different times were analyzed,and adverse reactions during treatment in two groups were compared. Results Intraoperative bleeding in observation group was less than that of the control group（ P〈0. 05）. The differences of operation time,drainage and anal exhaust time between the two groups were not statistically significant（ P〈0. 05）. SBP,DBP,HR after injection 5,10,15 min had significant differences with those indexes before injection（ P〈0. 05）. No statistical significant difference was found those indexed after injection 30 min with before injection（ P〈0. 05）.SBP,DBP,HR 5 min and 10 min,15 min after injection in control group were lower than those in the observation group（ P〈0. 05）. The total incidence rate of adverse reactions between the two groups（ blood pressure,heart rate fluctuations,wound hematoma,delayed healing,fever,infection） had no significant difference（ P〈0. 05）. Conclusion Compared with one-off injection of pituitrin,interval injection of pituitrin in laparoscopic hysteromyoma resection can reduce intraoperative blood loss,and the influence on circulatory system is more mild,the operation effect is the same. Therefore,it is worth for clinical popularization and application.