马来酸麦角新碱、卡贝缩宫素和卡前列素氨丁三醇在阴道分娩中治疗宫缩乏力性产后出血的安全性和有效性

Safety and efficacy of ergometrine maleate, carbetocin and carboprost tromethamine in the treatment of uterine atony postpartum hemorrhage in vaginal delivery

目的分析比较马来酸麦角新碱、卡贝缩宫素和卡前列素氨丁三醇在阴道分娩中治疗宫缩乏力性产后出血的安全性和有效性。方法选择本院2015年1月至2018年6月收治的90例阴道分娩宫缩乏力产妇作为研究对象,根据分娩用药情况将其分为马来组(n=30,马来酸麦角新碱)、卡贝组(n=30,卡贝缩宫素)、卡前组(n=30,卡前列素氨丁三醇)。分析三种用药方案对产妇产后阴道出血量、产后出血率、第三产程、血常规、凝血功能指标、生命体征及用药安全性的影响。结果三组产妇产后2、24 h阴道出血量、产后24 h血红蛋白及红细胞下降值比较,差异显著(P<0.05),且卡贝组产后阴道出血量最少,血红蛋白及红细胞下降值最低。三组产妇产后出血发生率、第三产程、产前及产后24 h凝血指标、用药前及用药1 h后血压及心率比较,差异无统计学意义(P>0.05)。马来组未出现不良反应,卡贝组出现1例面红患者,卡前组出现恶心呕吐、血压升高者各1例。结论在阴道分娩中实施马来酸麦角新碱、卡贝缩宫素、卡前列素氨丁三醇三种药物治疗的总有效率及安全性相当,且卡贝缩宫素可作为宫缩乏力性产后出血防治药物的首选。

Objective To analyze and compare the safety and effectiveness of ergonosine maleate, carbetocin and carboprost tromethamine in the treatment of uterine atony postpartum hemorrhage in vaginal delivery. Methods Ninety vaginal delivery women with uterine atony admitted in our hospital from January 2015 to June 2018 were selected as the study objects and divided into ergometrine maleate group(n=30, treated with ergometrine maleate), carbetocin group(n=30,treated with carbetocin) and carboprost tromethamine group(n =30, treated with carboprost tromethamine) by delivery medication. The effects of three medication schemes on postpartum vaginal bleeding volume, postpartum bleeding rate, third stage of labor, blood routine, coagulation function indexes, vital signs and medication safety were analyzed. Results There were significant differences in the amount of vaginal bleeding at postpartum 2 and 24 hours and the decrease of hemoglobin and erythrocyte at postpartum 24 hours among the three groups(P<0.05), and the carbetocin group had the lowest amount of vaginal bleeding and decrease of hemoglobin and erythrocyte. There were no significant differences in the incidence of postpartum hemorrhage, the third stage of labor, coagulation indexes before and at 24 hours after delivery, blood pressure and heart rate before and at 1 hour after medication among the three groups(P>0.05). There was no adverse reactions in the ergometrine maleate group, 1 case of blush in the carbetocin group, and 1 case of nausea and vomiting and 1 case of blood pressure increased in the carboprost tromethamine group. Conclusion The overall efficacy and safety of ergonosine maleate, carbetocin and carboprost tromethamine applied in vaginal delivery are comparable. Carbetocin can be the first choice for the prevention and treatment of uterine atony postpartum hemorrhage.