妊娠合并子宫肌瘤患者剖宫产同时行子宫肌瘤剥除术术中用药探讨

Drugs application in leiomyomata encleation and cesarean section for pregnancy women with uterine fibroids

目的探讨妊娠合并子宫肌瘤患者剖宫产同时行子宫肌瘤剥除术的术中用药情况及临床效果。方法将2017年6月至2019年3月郑州大学第三附属医院收治的120例妊娠合并子宫肌瘤产妇随机分为对照组(90例)与观察组(30例),其中对照组分为对照A组、对照B组、对照C组,每组30例。观察组采用卡前列素氨丁三醇注射液(安列克)子宫肌层注射,对照A组应用缩宫素加卡前列素氨丁三醇,对照B组应用缩宫素加卡贝缩宫素,对照C组应用缩宫素加卡前列素氨丁三醇加卡贝缩宫素。记录对照组与观察组患者的手术时间、术后出血率、住院时间、产后恶露干净时间以及并发症发生率。结果观察组与对照组产妇手术时间比较差异有统计学意义(P<0.05)。观察组产妇术后出血量、产后恶露干净时间、术后24h阴道出血量均少于对照组(P<0.05),但两组间其他各项指标比较差异未见统计学意义(P>0.05)。结论在妊娠合并子宫肌瘤剖宫产中同时行子宫肌瘤剥除术术中用药非常关键,采用卡前列素氨丁三醇注射液子宫肌层注射可以显著缩短手术时间,减少术中出血量,减轻患者痛苦,避免进行二次手术,降低并发症的发生率,更加安全有效,值得临床推广。

Objective To investigate the effects of different drugs in leiomyomata encleation and cesarean section for pregnancy women with uterine fibroids. Methods A total of 120 pregnant women undergoing cesarean section for pregnancy with uterine fibroids in the Third Affliated Hospital of Zhengzhou University from June 2017 to March 2019 were randomly divided into control group (90 patients) and observation group (30 patients). While the control group was further divided into three groups: group A, B and C, with 30 cases in each group. Patients in the observation group were injected with the prosthetic mycelium of the anterior cyclin tromethamine injection (Alex), the group A with oxytocin plus carboprost tromethamine, the group B with oxytocin plus card, and the group C with oxytocin plus carbaryl tromethamine plus carbetocin. The operation time, postoperative bleeding rate, hospital stay, clean time of postpartum lochia, and incidence of complications were recorded in the control group and observation group. Results The operation time was (62.14±11.62)min in the group A,(65.15±9.11)min in the group B, and (61.25±5.77)min in the group C. The operation time of the observation group was (43.02±9.17)min, and the operation time was significantly different in pairwise comparison of the observation group with the control groups (P<0.05). There was a significant difference in the amount of intraoperative blood loss, postpartum lochia clean time and 24 h postoperative vaginal bleeding between the control groups and the observation group (P<0.05), the other indicators were not significantly different in pairwise comparison of the observation group with control groups (P>0.05). Conclusions It is very important to use uterine fibroids enucleation in the cesarean section of pregnancy with uterine fibroids. The use of carprostol tromethamine injection (Alex) for myometrial injection can greatly shorten the operation time, reduce the amount of intraoperative blood loss, alleviate the pain of patients, avoid secondary surgery, decrease the occurrence of complications;and it is safer and more effective. So it is worthy of clinical promotion.