氨甲环酸联合缩宫素预防剖宫产产后出血的效果及对凝血功能的影响

Clinical Effectiveness of Tranexamic Acid Combined with Oxytocin in Prevention of Postpartum Hemorrhage after Cesarean Section and Its Effect on Coagulation Function

目的氨甲环酸联合缩宫素预防剖宫产产后出血的效果及对凝血功能的影响。方法选取2018年6月-2019年3月于我院进行剖宫产分娩的120例产妇作为研究对象,根据预防产后出血方法的不同分为观察组58例和对照组62例。对照组在胎儿娩出后给予静脉滴注及宫体注射缩宫素各20 U;观察组在对照组治疗基础上加用氨甲环酸注射液。观察2组术后2 h、24 h出血量及产后出血发生率;比较2组子宫收缩持续时间、子宫底下降速度、术前及术后24 h凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(FIB)水平变化及不良反应发生情况。结果观察组术后2 h、24 h出血量均少于对照组,且产后出血率低于对照组(P<0.05,P<0.01)。与对照组比较,观察组宫缩持续时间延长,子宫底下降速度加快(P<0.05)。术后24 h,2组PT、APTT水平均缩短,FIB水平均升高,且观察组上述指标缩短及升高程度均大于对照组(P<0.05)。2组治疗期间总不良反应发生率比较差异无统计学意义(P>0.05)。结论氨甲环酸联合缩宫素预防剖宫产产后出血效果良好,能够明显降低产后出血发生率并促进产后恢复,且能改善产妇凝血功能状态,且治疗安全性良好。

Objective To investigate clinical effectiveness of Tranexamic Acid combined with Oxytocin in prevention of postpartum hemorrhage after cesarean section and its effect on coagulation function. Methods A total of 120 parturients, who delivered by cesarean section during June 2018 and March 2019, were divided into observation group(n=58) and control group(n=62) according to different methods of preventing postpartum hemorrhage. All parturients underwent cesarean section through transverse incision of lower uterine segment under continuous epidural anesthesia. Control group received intravenous drip of 20 U Oxytocin and intrauterine injection of 20 U Oxytocin after delivery, while observation group was added Tranexamic Acid on the basis of treatment for control group. In two groups, bleeding volume and incidence rate of postpartum hemorrhage at 2 h and 24 h after operation were compared;duration of uterine contraction and descent speed of uterus fundus after administration were compared;changes of prothrombin time(PT), activated partial thromboplastin time(APTT) and fibrinogen(FIB) levels before and at 24 h after operation were compared;incidence rates of adverse reactions during treatment were observed and compared. Results In observation group, volumes of postpartum hemorrhage at 2 h and 24 h after operation were less, and rate of postpartum hemorrhage was significantly lower than those in control group(P<0.05, P<0.01). Compared with those in control group, duration of uterine contraction was prolonged, and descent speed of uterus fundus was accelerated in observation group(P<0.05). At 24 h after operation, PT and APTT levels were significantly decreased, while FIB levels were significantly increased in two groups, and the decreased or increased degrees in the above indexes in observation group were more than those in control group(P<0.05). There was no significant difference in incidence rate of total adverse reactions between two groups(P>0.05). Conclusion Tranexamic Acid combined with Oxytocin has good effectiveness in prevention of postpartum hemorrhage after cesarean section, can significantly reduce the incidence of postpartum hemorrhage and promote postpartum recovery, and it may effectively reduce incidence rate of postpartum hemorrhage, promote postpartum recovery and improve coagulation function of puerpera with good safety.