卡贝缩宫素预防剖宫产高危产妇产后出血及凝血功能的疗效

Effects of carbetocin on prevention of postpartum hemorrhage and coagulation function in high-risk pregnant women with cesarean section

目的 评价卡贝缩宫素预防剖宫产高危产妇产后出血及凝血功能的疗效。方法 回顾性分析核工业四一六医院·成都医学院第二附属医院2016年1月至2016年12月收治的427例剖宫产高危产妇的临床资料,根据治疗方法不同,分为卡贝组(156例)和缩宫素组(271例),比较分析两组产妇术中、产后2h、产后24h出血量及出血率,第三产程时间,凝血功能,血红蛋白水平,血压、心率变化,不良反应的发生情况。结果 卡贝组的出血量及第三产程时间、加用卡前列素氨丁三醇注射液比例和产后24h出血率均低于缩宫素组(P<0.05)。术后两组血浆纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer,D-D)水平均高于术前(P<0.05),凝血酶原时间(prothrombin time,PT)、部分凝血活酶时间(activated partial thromboplastin time,APTT)时间均短于术前,除缩宫素组PT差异无显著性(P>0.05)外,差异均有显著性(P<0.05)。术后卡贝组产妇凝血功能(FIB、D-D水平更高,PT、APTT时间更低)均优于缩宫素组(P<0.05)。两组产妇手术前后心率和血压基本无变化(P>0.05),但缩宫素组血红蛋白下降水平明显高于卡贝组(P<0.05)。术后卡贝组产妇出现不良反应4例,缩宫素组出现不良反应3例。结论 使用卡贝缩宫素可有效降低产后出血概率及出血量,改善凝血功能且不良反应少。

Objective To explore the effects of carbetocin on prevention of postpartum hemorrhage and coagulation function in high-risk pregnant women with cesarean section.Method The clinical data of 427 high-risk pregnant women with cesarean section from January 2016 to December 2016 in our hospital were retrospectively analyzed.According to different treatment methods,they were divided into carbetocin group(156 cases)and oxytocin group(271 cases).The hemorrhage volume during operation and at 2h and 24h after delivery,time of third stage of labor,coagulation function,hemoglobin level,blood pressure,heart rate and occurrence of adverse reactions were counted in the two groups.Result The hemorrhage volume during operation and at 2h and 24h after delivery and the time of third labor time in carbetocin group were lower than those in control group(P<0.05),and the postpartum hemorrhage rate in carbetocin group was lower than that in control group(P<0.05).The levels of FIB and D-D in carbetocin group after operation were significantly increased and were higher than those in oxytocin group(P<0.05),and the levels of PT and APTT were significantly decreased and were lower than those in oxytocin group(P<0.05).The levels of FIB and D-D in oxytocin group after operation were significantly increased(P<0.05)while the APTT level was decreased significantly(P<0.05),and there were no significant changes in the levels of PT(P>0.05).There were no changes in heart rate and blood pressure between the two groups before and after operation(P>0.05),and the decreased value of hemoglobin in carbetocin group was significantly lower than that in oxytocin group(P<0.05).Postoperative adverse reactions occurred in 4 cases in carbetocin group and 3 cases in oxytocin group.Conclusion Carbetocin can effectively reduce the probability of postpartum hemorrhage and the hemorrhage volume,improve coagulation function and it has good safety,and it will not increase the body burden on patients.Thus it is worthy of promotion and application in the prevention of postpartum hemorrhage.