卡前列素氨丁三醇注射液配合宫腔填塞碘仿纱布在前置胎盘产后出血中的临床应用

Clinical application of carboprost trometamol injection combined with intrauterine plugging with iodoform gauze in patients with postpartum hemorrhage due to placenta previa

目的对卡前列素氨丁三醇注射液配合宫腔填塞碘仿纱布在120例前置胎盘产后出血的临床应用效果进行分析与探究。方法选择2012年1月至2016年1月收治的120例前置胎盘患者,均行剖宫产手术且因前置胎盘导致产后出血,采用随机数字表法分为观察组和对照组,每组60例。观察组:胎儿娩出后子宫体肌内注射卡前列素氨丁三醇注射液250μg、缩宫素30 U,缩宫素10 U静脉滴入,待胎盘剥离后缓慢娩出胎盘,对胎盘剥离后子宫出血凶猛者,采用1-0可吸收线"8"字或"U"型缝扎止血,待明显好转后,行碘仿纱布条连接后填塞于宫腔下段。对照组:胎儿娩出后子宫体部肌内注射缩宫素30 U,缩宫素10 U静脉滴入,同时给予产妇舌下含服米索前列醇200μg。然后对观察组和对照组对产后出血量、产褥感染率、子宫切除率、手术时间及药物不良反应等进行比较。结果经治疗后,观察组患者术中的出血量为(1 076.75±256.22)ml,产后24 h出血量(1 224.67±104.15)ml,与对照组相比明显较低,差异有统计学意义(P<0.05)。观察组子宫切除率、产褥感染率手术时间均较对照组明显降低,差异有统计学意义(P<0.05)。而2组患者的不良反应发生率差异无统计学意义(P>0.05)。结论卡前列素氨丁三醇注射液联合宫腔填塞碘仿纱布用于前置胎盘治疗产后出血的效果显著。对于减少产后出血、避免子宫切除、降低产褥感染率、节省手术时间、节省血源、降低住院费用中均起到重要作用,值得进一步推广。

Objective To investigate the clinical application of carboprost trometamol injection combined with intrauterine plugging with iodoform gauze in patients with postpartum hemorrhage due to placenta previa.Methods A total of 120 patients with postpartum hemorrhage due to placenta previa who underwent cesarean section in our hospital from January 2012 to January 2016 were randomly divided into observation group(n=60)and control group(n=60)according to random number table.The patients in observation group were treated by injecting into uterine musculature carboprost tromethamine 250μg and oxytocin 30 units after delivery,with oxytocin 10 units being infused by intravenous drip.The placenta was delivered slowly after being peeled off.If the uterine bleeded violently,suturing in“8”or“U”shape with absorbable suture to stop bleeding.Once the situation was obviously improved,linking iodoform gauze and plugging it in the lower uterine segment.However the patients in control group were treated by injecting into uterine musculature 30 units of oxytocin,with other 10 units being infused by intravenous drip,at the same time,taking sublingual misoprostol for 200μg.Then the postpartum hemorrhage volume,puerperal infection rate,hysterectomy rate,operation time and adverse drug reactions were compared and compared between two groups.Results After treatment,the intraoperative hemorrhage volume in observation group was(1,076.75±256.22)ml,and(1,224.67±104.15)ml at 24 hours after delivery,which was significantly lower than those in control group(P<0.05).The puerperal infection rate,hysterectomy rate and operation time in observation group were significantly lower than those in control group(P<0.05).However there was no significant difference in incidence rate of adverse reactions between two groups(P>0.05).Conclusion The combination application of carboprost trometamol and intrauterine plugging with iodoform gauze has obvious therapeutic effects on postpartum hemorrhage due to placenta previa,which can reduce postpartum hemorrhage,avoid hysterectomy,decrease puerperal infection rate,save operation time,save blood source and reduce hospital costs,therefor,which is worth using widely in clinical practice.