预防性应用氨甲环酸减少瘢痕子宫剖宫产出血的临床观察

A clinical observation on the prophylatic effect of tranexamic acid of postpartum hemorrhage during and after cesarean section of scar uterine

目的:研究氨甲环酸(TXA)在预防瘢痕子宫剖宫产术后产后出血和减少产后出血量中的作用。方法:将168例因剖宫产史行选择性剖宫产的孕妇随机分为研究组(82例)与对照组(86例),于剖宫产术中胎儿娩出后2min内分别接受1g TXA静脉滴注或生理盐水。记录术中出血量、术后至产后2h出血量、产后2~24h出血量。产后第一天检查肝肾功能、凝血功能、血常规,观察并记录产妇的不适主诉。结果:两组的术中出血量比较,差异无统计学意义[(381.3±185.77)ml vs(366.3±130.23)ml,P=0.548]。研究组术后至产后2h出血量、产后2~24h出血量及产后24h总出血量均显著低于对照组,差异均有统计学意义[术后至产后2h出血量:(44.5±42.97)ml vs(70.4±77.69)ml,P=0.008;产后2~24h出血量:(90.0±54.70)ml vs(141.3±133.92)ml,P=0.044;产后24h总出血量:(492.3±156.99)ml vs(585.4±198.05)ml,P=0.033]。与对照组比较,研究组术后血红蛋白下降程度较轻[(2.93±8.24)g/L vs(5.53±8.27)g/L,P=0.043],随访期间无药物不良反应及血栓栓塞性疾病发生。结论:胎儿娩出后预防性应用1g TXA能减少因瘢痕子宫行剖宫产产妇的产后出血量。

Objective:T o evaluate the efficacy of prophylactic tranexamic acid in reducing the blood loss during and after elective repeat lower segment cesarean section.Method s:168 cases of elective repeat cesarean section pregnant women were divided into the study group(n=82)and control group(n=86).The pregnant women received 1 gram tranexamic acid or normal saline intravenously within 2 minutes after the delivery of the fetus.Blood loss was calculated as three parts:from delivery of the neonate to the end of cesarean section,from the end of cesarean section to 2 hours postpartum,and from 2 hours to 24 hours postpartum.We also recorded the hepatorenal function,coagulation function,blood routine test at the first day after operation,and adverse reaction.Results:Although no significant differences was found in the blood loss from delivery of the fetus to the end of cesarean section between two groups[(381.3±185.77)ml vs(366.3±130.23)m l,P=0.548],the amount of blood loss from the end of cesarean section to 2 hours postpartum bleeding,postoperative bleeding 2-24 hours postpartum bleeding,and totally in 24hours were significantly lower in the study group than in the control group[(44.5±42.97)ml vs(70.4±77.69)m l,P=0.008;(90.0±54.70)ml vs(141.3土133.92)m l,P=0.044;(492.3±156.99)ml vs(585.4±198.05)ml,P=0.033].The postoperative hemoglobin decreased slightly in the study group(2.93±8.24 vs 5.53±8.27,P<0.05).No adverse reactions and thrombosis occurred during the study.Conclusion:The prophylactic intravenous of 1g tranexamic acid can reduce the postoperation blood loss and prevent the postpartum hemorrhage during and after cesarean section of scar uterine.