胎盘早剥致产后出血卡前列素氨丁三醇不同应用时机效果观察

Effect of different application time of carboprost tromethamine on postpartum hemorrhage caused by placental abruption

目的探讨胎盘早剥致产后出血卡前列素氨丁三醇不同应用时机效果,旨在为临床治疗提供参考依据。方法回顾性分析2015年12月至2019年12月宝鸡市妇幼保健院收治的90例胎盘早剥产妇临床资料,按照治疗方式不同分为A组和B组各45例。两组患者均以剖宫产分娩,胎儿娩出后均给予缩宫素治疗,A组在常规处理措施基础上于胎儿娩出后同时给予卡前列素氨丁三醇注射液治疗,B组在常规处理措施止血无效后再给予卡前列素氨丁三醇注射液治疗。比较两组产妇产后15 min、30 min、2 h及24 h的出血量,产后出血率、第三产程、产后出血时间、输血情况、子宫切除、子宫复旧不良情况及不良反应发生率。结果A组产妇产后15 min、30 min、2 h、24 h出血量及产后出血率分别为(234.12±25.51)mL、(255.95±27.04)mL、(291.04±24.18)mL、(394.03±36.17)mL、6.67%,明显少于对照组的(291.45±18.94)mL、(331.94±26.47)mL、(392.41±33.29)mL、(481.12±32.59)mL、22.22%,差异均有统计学意义(P<0.05);A组产妇第三产程、产后出血时间分别为(4.23±0.78)min、(14.23±2.61)h,明显短于B组的(7.06±1.37)min、(18.09±2.58)h,输血率、红细胞输注量、血浆输注量分别为8.89%、(4.74±0.74)U、(234.95±18.03)mL,明显少于B组的26.67%、(6.96±1.14)U、(317.94±27.04)mL,差异均有统计学意义(P<0.05);A组和B组产妇的子宫切除率分别为0和2.22%,差异无统计学意义(P>0.05);A组产妇的子宫复旧不良发生率为11.11%,明显低于B组的28.89%,差异有统计学意义(P<0.05);A组和B组产妇的恶心呕吐、胸闷、面部潮红、一过性血压升高的总发生率分别为13.33%和11.11%,差异无统计学意义(P>0.05)。结论在胎儿娩出后即刻使用卡前列素氨丁三醇治疗胎盘早剥可有效减少产妇产后出血,促进子宫复旧,且安全性好,值得推广应用。

Objective To study the effect of different application time of carboprost tromethamine on postpartum hemorrhage caused by placental abruption,in order to provide reference for clinical treatment.Methods The clinical data of 90 puerperants of placental abruption in the Maternal and Child Health Hospital of Baoji City from December 2015 to December 2019 were retrospectively analyzed.They were divided into group A and group B according to different treatment methods,with 45 cases in each group.The two groups of patients were delivered by cesarean section,and the fetus after delivery were given oxytocin treatment.Group A was given carboprost trometha mine injection at after fetal delivery on the basis of conventional treatment measures,and group B was given carboprost trometha mine injection treatment after routine treatment measures failed to stop bleeding.The bleeding volume at postpartum 15 min,30 min,2 h and 24 h,postpartum hemorrhage rate,third stage of labor,postpartum hemorrhage time,blood transfusion,hysterectomy,uterine involution,and incidence of adverse reactions were compared between the two groups.Results The amount of postpartum hemorrhage at postpartum 15 min,30 min,2 h and 24 h and postpartum hemorrhage rate in group A were(234.12±25.51)mL,(255.95±27.04)mL,(291.04±24.18)mL,(394.03±6.17)mL,and 6.67%,respectively,which were significantly less than corresponding(291.45±18.94)mL,(331.94±26.47)mL,(392.41±33.29)mL,(481.12±32.59)mL,22.22% in the control group(all P<0.05);the third stage of labor and postpartum hemorrhage time in group A were(4.23±0.78)min and(14.23±2.61)h,which were significantly shorter than corresponding(7.06±1.37)min and(18.09±2.58)h in the control group(P<0.05);the blood transfusion rate,red blood cell transfusion volume and plasma infusion volume were 8.89%,(4.74±0.74)U,(234.95±18.03)mL,respectively,which were significantly lower than corresponding 26.67%,(6.96±1.14)U,(317.94±27.04)mL in group B(all P<0.05);the hysterectomy rates of the group A and group B was 0 and 2.22%,with no statistically significant difference(P>0.05);the incidence of uterine involution in group A was 11.11%,which was significantly lower than 28.89% in group B(P<0.05);the total incidence of nausea and vomiting,chest tightness,facial flushing and transient hypertension in group A was 13.33%versus 11.11%in group B(P>0.05).Conclusion Immediate use of carboprost tromethamine in the treatment of placental abruption can effectively reduce puerpera postpartum hemorrhage,promote uterine involution,and have good safety,which is worthy of popularization and application.