卡前列素氨丁三醇治疗宫缩乏力性产后出血的应用时机及疗效观察

The application timing and curative effect of carprostol tromethamine in the treatment of postpartum hemor-rhage due to uterine atony

目的 探讨卡前列素氨丁三醇治疗剖宫产术后宫缩乏力性产后出血的应用时机,并观察临床疗效.方法 选取连云港市第二人民医院2016年1月至2018年6月治疗的宫缩乏力性产后出血患者62例为研究对象,采用随机数字表法分为两组,每组31例.对照组:胎儿娩出后静脉滴注缩宫素20 U,胎盘剥离面如有活动性出血,继续用缩宫素40 U,如果仍有出血,再用卡前列素氨丁三醇250 μg宫体注射.观察组:胎儿娩出后静脉滴注缩宫素20 U,如果胎盘剥离后仍然有活动性出血,立即予卡前列素氨丁三醇250 μg宫体注射.如果两组患者经上述处理后子宫仍有活动性出血,则予纱布条宫腔填塞止血或者行子宫动脉结扎术.记录并比较两组产妇术中、术后2 h和24 h出血量、产后24 h血红蛋白(Hb)下降值以及治疗有效率,并记录两组不良反应发生率.结果 观察组术中出血量为(1 066.1 ±71.3) mL,明显少于对照组的(1 163.6 ± 70.9)mL,差异有统计学意义(t=5.393,P<0.001).两组术后2 h和24 h出血量差异均无统计学意义(均P>0.05).观察组产后24 h Hb下降值为(20.80 ±6.25)g/L,低于对照组的(26.90 ±9.21) g/L,差异有统计学意义(t=3.033,P<0.01).观察组治疗有效率为87%(27/31),对照组为77%(24/31),两组差异无统计学意义(P>0.05).结论 剖宫产术后出现宫缩乏力性产后出血,可早期使用卡前列素氨丁三醇治疗,能有效减少产后出血量,促进患者康复,疗效优于缩宫素.

Objective To explore the application timing of carprostol tromethamine in the treatment of postpartum hemorrhage due to uterine atony ,and to observe the clinical efficacy.Methods From January 2016 to June 2018,62 patients with uterine atony and postpartum hemorrhage admitted to the Second People 's Hospital of Lianyungang were selected as study objects ,and they were randomly divided into two groups according to the digital table,with 31 cases in each group.In the control group,after the delivery of the fetus ,20U of oxytocin was intrave-nously injected.If there was active hemorrhage on the dissection surface of the placenta ,40U of oxytocin was contin-ued.If there was still hemorrhage,the uterus was injected with 250μg of carprostol tromethamine.In the observation group,after the delivery of the fetus ,20U of oxytocin was intravenously injected.If there was active hemorrhage on the dissection surface of the placenta ,250μg of carprostol tromethamine was injected immediately.If the patients in the two groups still had active bleeding in the uterus after the above treatments ,the uterine cavity was filled with gauze or uterine artery ligation was performed to stop bleeding.The blood loss during the operation ,2h and 24h after surgery were recorded and compared between the two groups.The 24h postpartum hemoglobin (Hb) decreased value,treatment efficacy and the incidence of adverse reactions were also recorded and compared between the two groups . Results The intraoperative blood loss was (1 066.1 ±71.3) mL in the observation group,which was significantly lower than that in the control group [(1 163.6 ±70.9) mL],the difference was statistically significant ( t=5.393, P<0.001).There were no statistically significant differences in 2h and 24h postoperative blood loss between the two groups (all P>0.05).The decrease of Hb in the observation group at 24h after birth was (20.80 ±6.25)g/L,which was lower than that in the control group [(26.90 ±9.21) g/L],and the difference was statistically significant ( t= 3.033,P<0.01).The treatment effective rate of the observation group was 87%(27/31),which of the control group was 77%( 24/31 ), there were no statistically significant differences between the two groups ( P >0.05 ). Conclusion Postpartum hemorrhage caused by uterine atony can be treated by early use of carprostol tromethamine , which can effectively reduce postpartum bleeding and promote the rehabilitation of patients .The curative effect is better than oxytocin,and it is worthy of clinical application.