马来酸麦角新碱三针法预防瘢痕子宫再次妊娠产后出血的临床观察

Three-dose Regimen of Ergometrine Maleate for Prevention of Postpartum Hemorrhage in Scarred Uterus in a Repeat Caesarean Section

目的为预防瘢痕子宫再次妊娠剖宫产时产后出血的发生,探索合理的宫缩剂给药方案。方法将100例瘢痕子宫足月剖宫产产妇,随机分为马来酸麦角新碱组(Ergometrine Maleate,E组)和卡贝缩宫素组(Carbetocin,C组),每组50例,在常规使用缩宫素的基础上,分别于术中开始给予马来酸麦角新碱肌肉注射(E组)或卡贝缩宫素持续静脉滴注(C组),观察并记录术中、术后24h的出血量以及手术前后血红蛋白(Hb)的变化。结果所有产妇无一人发生严重的产后大出血。E组和C组两组产妇术中出血量分别为(469.7±147.1)mL和(487.8±163.2)mL,差异无统计学意义;但是E组术后出血量及总出血量(198.3±95.7)/(668.0±207.0)mL均明显低于C组(280.2±145.7)/(768.0±223.2)mL,差异具有统计学意义(均P<0.05)。两组术前Hb差异无统计学意义,但是术后第2天E组Hb[(109.1±10.8)g/L]明显高于C组[(103.9±12.0)g/L],差异具有统计学意义。结论两种方法均可以有效预防产后出血发生。与卡贝缩宫素比较,马来酸麦角新碱肌肉注射分次给药方案在减少术中出血方面无明显优势,但在预防术后出血方面优于持续静脉滴注卡贝缩宫素。

Objective To explore a reasonable administration program for uterine contraction in order to prevent postpartum hemorrhage during cesarean section in patients with a scarred uterus.Methods One hundred parturients with a scarred uterus who planned to give birth by elective repeat cesarean delivery at term were randomly divided into two groups(n=50 each).Oxytocin(10 units)was given to the pregnant women in the two groups on a routine basis.Besides,0.2 mg ergometrine maleate was injected intramuscularly at three different time points in ergonovine group(after the delivery of the placenta,at the time back to the obstetric ward,and at 12 hafter the delivery of the fetus),while 100μg carbetocin in 500 mL saline was infused intravenously from the delivery of the placenta until 24 hafter the delivery of fetus in carbetocin group.Blood loss during the operation and 24 hafter the operation were measured and compared between the two groups.Hemoglobin levels before and 2 days after the operation were also compared between the two groups.Results No participant experienced severe postpartum hemorrhage.There was no significant difference in the mean blood loss during the operation between the two groups[(469.7±147.1)mL and(487.8±163.2)mL,P >0.05].But the postoperative blood loss and the total blood loss were(198.3±95.7)and(668.0±207.0)mL in the ergonovine group,significantly lower than those in the carbetocin group[(280.2±145.7)and(768.0±223.2)mL,respectively,P=0.001].No significant difference was found in the hemoglobin loss in the operation between the two groups.However,the hemoglobin level in the ergonovin group was statistically higher than that in the control group[(109.1±10.8)g/L and(103.9±12.0)g/L,respectively,P=0.018]on the second day of surgery.Conclusion Both ergometrine maleate and carbetocin are effective for preventing the hemorrhage of cesarean delivery.Compared with carbetocin,ergometrine maleate showed no difference in decreasing the intra-operative blood loss,but it was more effective for reducing post-operative blood loss.