不同药物联合缩宫素对预防剖宫产高危产妇产后出血的效果及对凝血功能的影响

Efficacy of Various Drug Combined with Oxytocin in Prevention of Postpartum Hemorrhage of High-risk Pregnant Women with Cesarean Section and Its Effect on Coagulation Function

目的探讨马来酸麦角新碱、卡贝缩宫素及卡前列素氨丁三醇联合缩宫素对预防剖宫产高危产妇产后出血及凝血功能的影响。方法对2015年10月—2017年10月收治的行剖宫产的高危产妇400例的临床资料进行回顾性分析。根据产后给药不同分为A组124例、B组145例和C组131例。A组给予缩宫素联合马来酸麦角新碱,B组给予缩宫素联合卡贝缩宫素,C组给予缩宫素联合卡前列素氨丁三醇。比较3组产后2、24 h阴道出血量及出血率,手术前后红细胞和血红蛋白变化,凝血功能情况,用药前和用药后30 min生命体征变化及不良反应。结果 B组术后2、24 h出血量、红细胞和血红蛋白下降值、产后出血率均少于或低于A、C组(P<0.05)。B组凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial thromboplastin time,APTT)、D二聚体(D-Dimer,DD)均低于A、C组,纤维蛋白原(fibrinogen,Fbg)高于A、C组(P<0.05)。3组用药前后收缩压、舒张压和心率比较差异均无统计学意义(P>0.05)。C组不良反应发生率高于A、B组(P<0.05)。结论卡贝缩宫素应用于剖宫产高危产妇产后出血的预防效果最为显著,且不良反应少,可作为缩宫素联合使用药物首选,但同时应考虑患者临床情况,给予个体化用药方案。

Objective To investigate effect of Ergometrine Maleate, Carbetoein Oxytoein and Carboprost Tromethamine and other various drugs combined with oxytoein in prevention of postpartum hemorrhage in high-risk pregnant women with cesarean section and the effect on coagulation function. Methods Clinical data of 400 high-risk pregnant women with cesarean section admitted during October 2015 and October 2017 was retrospectively analyzed, and the patients were divided into A group （n = 124）, B group （n = 145 ） and C group （n = 131 ） according to different postpartum medications. Group A was given oxytoein combined with Ergometrine Maleate, and group B was given oxytoein combined with Carbetoein Oxytoein, and group C was given oxytoein combined with Carboprost Tromethamine. Vaginal bleeding volumes and bleeding rate at 2 h and 24 h after delivery, changes of red blood cell （RBC） and hemoglobin levels before and after operation, condition of coagulation function, changes of vital signs before medication and at 30 min after medication and adverse reactions were compared among three groups. Results In group B, values of blood loss volume at 2 h and 24 h after surgery, RBC and hemoglobin levels were lower, and postpartum bleeding rate was lower than those in group A and C （P 〈 0.05）. In group B, prothrombin time （ PT）, activated partial thromboplastin time （APTF）, D - dimer （D-D） were lower, while fibrinogen （Fbg） level was higher than those in group A and C （P 〈 0.05 ）. There were no statistically significant differences in levels systolic blood pressure, diastolic blood pressure and heart rate among three groups （P 〉 0.05 ）. Incidence rate of adverse reactions in group C was higher than those in group A and group B （P 〈 0.05 ）. Conclusion Carbetoein Oxytoein in prevention of postpartum hemorrhage in high-risk pregnant women with cesarean section may achieve the most obvious effect with few adverse reactions, and it can be used as the first choice of oxytocin medication, but it should take into account patients＇ clinical situation and individualized drug program simuhaneously.