不同前列腺素类药物联合缩宫素对瘢痕子宫产妇再次剖宫产产后出血的预防效果

Prophylactic effect of different prostaglandins combined with oxytocin on postpartum hemorrhage after repeated cesarean section in women with scar uterus

目的探讨不同前列腺素类药物联合缩宫素对瘢痕子宫产妇再次剖宫产产后出血的预防效果。方法将90例瘢痕子宫产妇随机分为A组和B组,每组45例。A组给予阴道填塞卡前列甲酯栓,B组给予卡前列素氨丁三醇注射液。观察术中2 h和产后2、24 h出血量,并比较2组产后出血、输血率和产后不良反应发生情况。结果产后2 h,2组活化部分凝血活酶时间(APTT)、血浆凝血酶时间(TT)和纤维蛋白原(Fib)水平均低于术前,且B组APTT、TT、Fib水平均低于A组,差异有统计学意义(P <0.05)。给药后,B组子宫收缩持续时间长于A组,子宫底下降速度快于A组,差异有统计学意义(P <0.05)。B组产后2、24 h出血量均少于A组,差异有统计学意义(P <0.05)。2组产后不良反应发生率比较,差异无统计学意义(P>0.05)。结论卡前列甲酯栓和卡前列素氨丁三醇对瘢痕子宫产妇再次剖宫产产后出血的预防效果相近,但卡前列素氨丁三醇在促进子宫收缩、改善凝血功能和减少产后出血量方面效果更佳。

Objective To explore the preventive effect of different prostaglandins combined with oxytocin on postpartum hemorrhage after repeated cesarean section in women with scar uterus.Methods A total of 90 pregnant women with scar uterus were randomly divided into group A and group B,with 45 cases in each group. Group A was given vaginal cramping with carboprost methylate suppositories,group B was given carboprost tromethamine injection. Intraoperative blood loss at 2 h and at 2,24 h after delivery were observed,and the incidence of postpartum hemorrhage,blood transfusion rate and postpartum adverse reactions were compared between the two groups. Results After 2 h postpartum,the activated partial thromboplastin time (APTT),plasma thrombin time (TT) and fibrinogen (Fib) levels in both groups were significantly lower than those before surgery,and the levels of APTT,TT and Fib in group B were significantly lower than those in group A (P < 0. 05). After drug administration,the duration of uterine contraction in group B was significantly longer than that in group A,and the speed of uterine floor decline was significantly faster than that in group A (P <0. 05). The blood loss in group B at 2,24 h after delivery was significantly less than those in group A (P < 0. 05). There was no statistically significant difference in the incidence of postpartum adverse reactions between the two groups (P > 0. 05). Conclusion Carboprost methylate suppositories has similar effect compared with carboprost tromethamine injection in the prevention of postpartum hemorrhage after cesarean section in women with scar uterus. But carboprost tromethamine injection is more effective in promoting uterine contractions,improving blood clotting and reducing postpartum blood loss.