卡贝缩宫素对妊娠疤痕子宫剖宫产术中出血量及子宫肌层厚度的影响

Effect of Carbetocin on Hemorrhage and Myometrial Thickness in Cesarean Section of Pregnancy Scar

目的研究妊娠疤痕子宫剖宫产术时采用卡贝缩宫素对术中出血量及子宫肌层厚度的影响。方法将2017年1—12月收治的妊娠疤痕子宫产妇88例,按随机数字法分为参照组和研究组各44例,参照组采用普通缩宫素,研究组采用卡贝缩宫素。比较两组术手术时间、术中出血量、住院时间、宫缩效果以及肌层变化和并发症发生情况。结果研究组住院时间(6.42±2.25)d略短于参照组(7.05±2.62)d,差异无统计学意义(t=1.210,P>0.05);不良反应发生率6.82%稍低于参照组的11.36%,差异无统计学意义(χ~2=0.550,P>0.05);手术时间(92.06±11.58)min和术中出血量(217.67±38.94)mL均显著少于参照组(123.75±13.08)min、(304.05±52.83)mL,均差异有统计学意义(t=12.033、8.730,P<0.05);研究组宫缩优良率为88.64%显著高于参照组的70.45%,差异有统计学意义(χ~2=4.46,P<0.05);子宫前壁(8.47±1.23)mm、子宫后壁(8.13±1.51)mm和宫底壁等肌层厚度(8.59±1.32)mm均显著厚于参照组(6.45±1.54)、(6.86±1.37)、(7.01±1.18)mm,差异有统计学意义(t=6.798、4.132,5.919,P<0.05)。结论在妊娠疤痕子宫行剖宫产术时采用卡贝缩宫素效果显著,可有效缩短手术时间,减少产妇术中出血量,促进子宫前后壁及宫底肌层厚度恢复,并不会增加不良反应发生率和延长住院时间,具有较高的安全性。

Objective To study the effect of carbetocin on intraoperative blood loss and myometrial thickness during cesarean section of pregnancy scar uterus. Methods Eighty-eight women with pregnancy-induced scar uterus admitted from January to December 2017 were randomly divided into a reference group and a study group of 44 cases. The reference group used ordinary oxytocin. The operation time, intraoperative blood loss, hospitalization time, uterine contraction effect, and changes of muscle layer and complications were compared between the two groups. Results The length of hospital stay （6.42±2.25） d was slightly shorter than that of the reference group （7.05±2.62）d, the difference was not statistically significant （t=1.210, P〉0.05）; the incidence of adverse reactions was 6.82% slightly lower than the reference group of 11.36%, but the difference was not statistically significant （χ2=0.550, P〉0.05）; the operation time （92.06±11.58） min and the intraoperative blood loss （217.67±38.94）mL were significantly less than the reference group （123.75±13.08） min, （304.05±52.83）mL, the difference was statistically significant （t=12.033, 8.730, P〈0.05）; the excellent and good rate of contraction in the study group was 88.64% significantly higher than the reference group 70.45%, the difference was statistically significant （χ2=4.46, P〈0.05）; anterior wall of the uterus （8.47±1.23）mm, posterior wall of the uterus（8.13±1.51）mm, and thickness of the uterine wall （8.59±1.32）mm were significantly thicker than the reference group （6.45±1.54）, （6.86±1.37）, （7.01±1.18）mm, the difference was statistically significant （t=6.798, 4.132, 5.919, P〈0.05）. Conclusion Carbetocin is effective in cesarean section of pregnancy scar uterus, which can effectively shorten the operation time, reduce the amount of bleeding during maternal surgery, and promote the recovery of uterine anterior and posterior wall muscle thickness, and will not increase the incidence of adverse reactions and prolonged hospital stay, with a high degree of safety.