益母草注射液联合双侧子宫动脉上行支结扎术用于难治性产后出血的疗效及对患者卵巢功能的影响

Efficacy of Motherwort Injection Combined with Bilateral Ascending Ligation of Uterine Artery on Refractory Postpartum Hemorrhage and its Effectson Ovarian Function

目的:探讨益母草注射液联合双侧子宫动脉上行支结扎术用于难治性产后出血的疗效及对患者卵巢功能的影响。方法:选取2015年9月至2019年1月秦皇岛军工医院收治的行剖宫产术并确诊为难治性产后出血的患者130例,采用随机数字表法分为对照组和研究组,每组65例。对照组患者采用双侧子宫动脉上行支结扎术止血,研究组患者在对照组的基础上加用益母草注射液治疗。观察两组患者的止血效果、子宫切除和产褥热发生情况、外周血凝血功能相关指标[凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、纤维蛋白原降解产物(FDP)和D-二聚体(D-D)]及卵巢功能指标[雌二醇(E2)、黄体生成素(LH)和卵泡刺激素(FSH)]水平,分析益母草注射液相关不良反应发生情况。结果:两组患者术中出血量的差异无统计学意义(P>0. 05);研究组患者的术后24 h出血量、术后2周宫腔积血量明显少于对照组,术后3 d宫底高度明显低于对照组,血性恶露持续时间明显短于对照组,差异均有统计学意义(P<0. 05)。两组患者子宫切除率的差异无统计学意义(P>0. 05);研究组患者的产褥热发生率为32. 31%(21/65),明显低于对照组的70. 77%(46/65),差异有统计学意义(P<0. 05)。止血治疗后3 d,研究组患者的PT、APTT、FIB、FDP及D-D水平明显低于对照组;止血治疗后3个月,研究组患者的E2水平明显高于对照组,LH、FSH水平明显低于对照组,差异均有统计学意义(P<0. 05)。研究组患者治疗期间未发现严重益母草注射液相关不良反应。结论:益母草注射液联合双侧子宫动脉上行支结扎术用于难治性产后出血可提高患者止血效果,优化凝血功能,且在保护卵巢功能方面具有积极作用。

OBJECTIVE: To probe into the efficacy of motherwort injection combined with bilateral ascending ligation of uterine artery on refractory postpartum hemorrhage and its effects on ovarian function. METHODS: Totally 130 patients underwent cesarean section and diagnosed with refractory postpartum hemorrhage admitted into Qinhuangdao Cerebrovasculra Disease Hospital from Sept. 2015 to Jan. 2019 were extracted to be divided into the control group and the study group via the random number table,with 65 cases in each group. The control group was treated with bilateral ascending ligation of uterine artery,while the study group received motherwort injection bases on the control group. Hemostasis effects, hysterectomy and puerperal fever, peripheral blood coagulation function indicators [prothrombin time( PT),partial thromboplastin time( APTT),fibrinogen( FIB),fibrinogen degradation products( FDP) and D-dimer( D-D) ] and ovarian function indicators [estradiol( E2),luteinizing hormone( LH)and follicle stimulating hormone( FSH) ]levels of two groups were observed. And the adverse drug reactions induced by motherwort injection were analyzed. RESULTS: There was no significant difference in intraoperative blood loss between two groups( P>0. 05). The amount of bleeding at 24 h and the volume of intrauterine hemorrhage at 2 weeks in the study group were significantly less than those in the control group,the height of the uterine fundus was significantly lower than that of the control group at 3 d after surgery,the duration of lochia rubra was significantly shorter than that of the control group,with statistically significant differences( P < 0. 05). There was no significant difference in the hysterectomy rate between two groups( P>0. 05). The incidence of puerperal fever in the study group was 32. 31%( 21/65),significantly lower than that in the control group( 70. 77%,46/65),and the difference was statistically significant( P < 0. 05). After hemostasis of 3 d,the levels of PT,APTT,FIB,FDP and D-D in the observation group were significantly lower than those in the control group;after hemostasis of 3 months,the level of E2 in the observation group was significantly higher than that in the control group,and the levels of LH and FSH were significantly lower than those in the control group,and the differences were statistically significant( P < 0. 05). No severe adverse drug reactions induced by motherwort injection were observed during the observation period.CONCLUSIONS: Motherwort injection combined with bilateral ascending ligation of uterine artery on refractory postpartum hemorrhage can improve the hemostatic effects,optimize the coagulation function,and has a positive role in protecting ovarian function.