卡前列素氨丁三醇联合缩宫素对剖宫产产妇产后出血的疗效

Clinical trial of carprost tromethamine combined with oxytocin on postpartum hemorrhage of cesarean section women

目的观察卡前列素氨丁三醇联合缩宫素对剖宫产产妇产后出血的疗效。方法将118例产妇依据随机数字表法分为对照组59例与试验组59例。2组产妇均给予宫腔内纱布填塞止血。对照组给予头孢呋辛钠1.5 g+氯化钠注射液200 mL,每日1次,静脉滴注;缩宫素注射液20 U,填塞止血后宫内注射,再给予缩宫素注射液20 U+氯化钠注射液500 mL,每日1次,静脉滴注。试验组在对照组的基础上给予卡前列素氨丁三醇注射液250μg,填塞止血后宫内注射;如果患者出血情况未改善,则至少间隔15 min完成多次宫内注射,每次注射剂量250μg,用总剂量上限为2 mg。2组止血治疗时间均维持至少24 h。比较2组的产后出血情况、子宫复旧情况、恶露持续时间、产后1 d的收缩压与舒张压、产后1 d的凝血相关指标、止血效果与药物不良反应。结果治疗后,试验组和对照组的止血总有效率分别为96.61%(57例/59例)和83.05%(49例/59例),差异有统计学意义(P<0.05)。试验组和对照组产后2 h的出血量分别为(396.99±51.37)和(451.81±60.26)mL,产后6 h的出血量分别为(652.97±60.26)和(717.33±73.31)mL,产后12 h的出血量分别为(879.60±78.39)和(959.39±86.58)mL,产后24 h的出血量分别为(1 108.74±94.62)和(1 307.28±117.41)mL,差异均有统计学意义(均P<0.05)。试验组和对照组恶露持续时间和产后1,3,5 d的子宫底高度比较,差异均有统计学意义(均P<0.05)。试验组与对照组的产后1 d收缩压、舒张压、凝血相关指标对比,差异无统计学意义(P>0.05)。试验组和对照组的主要药物不良反应均为低血压、发热、腹泻、恶心、呕吐、胸闷。试验组和对照组的药物不良反应发生率分别为11.86%(7例/59例)和10.17%(6例/59例),差异无统计学意义(P>0.05)。结论用卡前列氨丁三醇联合缩宫素治疗剖宫产术后出血的产妇,有助于降低术后的出血量,促进子宫复旧,效果确切且安全性可靠。

Objective To observe the effect of carprost tromethamine combined with oxytocin on postpartum hemorrhage of cesarean section women. Methods According to the random number table method, 118 cases of parturients were divided into 59 cases in control group and 59 cases in treatment group. Women in both groups were given intrauterine gauze packing to stop bleeding. Control group was given cefuroxime sodium 1.5 g + sodium chloride injection 200 mL, once a day, intravenously;oxytocin injection 20 U, injected intrauterine after tamponade hemostasis, and then oxytocin injection 20 U+sodium chloride injection 500 m L,once a day,intravenous drip. Treatment group was given carprost tromethamine injection250 μg,intrauterine injection after hemostasis,if the patients ’ bleeding does not improve,multiple intrauterine injections should be completed at least 15 min apart,each time 250 μg,the upper limit of the total dose used was 2 mg,on the basis of control group. Hemostasis treatment time in both groups was maintained at least 24 h. The postpartum hemorrhage,uterine involution,the duration of lochia,the systolic and diastolic blood pressure on the 1 st postpartum,the coagulation-related indicators on the 1 st postpartum,the hemostatic effect and adverse drug reactions in two groups were compared. Results After treatment,the total effective rates of hemostasis in treatment group and control group were 96. 61%( 57 cases/59 cases) and 83. 05%( 49 cases/59 cases),with significant difference( P < 0. 05). The bleeding volume of treatment group and control group were( 396. 99 ± 51. 37) and( 451. 81 ± 60. 26) m L at 2 h postpartum,and the bleeding volume at 6 h postpartum were( 652. 97 ± 60. 26) and( 717. 33 ± 73. 31) m L,the bleeding volume at 12 h postpartum were( 879. 60 ± 78. 39) and( 959. 39 ± 86. 58) m L,the blood loss at 24 h postpartum were( 1 108. 74 ± 94. 62) and( 1 307. 28 ± 117. 41) m L,all with significant difference( all P < 0. 05). There was statistically significant difference in the duration of lochia and the fundus of the uterus between the treatment group and the control group on the 1 st,3 rd,and 5 th day after delivery( all P < 0. 05).There was no statistically significant difference between the systolic blood pressure,diastolic blood pressure and blood coagulation related indexes of the treatment group and the control group on the 1 st postpartum day( all P > 0. 05). The main adverse drug reactions in treatment group and control group were hypotension,fever,diarrhea,nausea,vomiting,and chest tightness. The incidence of adverse drug reactions in treatment group and control group were 11. 86%( 7 cases/59 cases) and 10. 17%( 6 cases/59 cases),without significant difference( P > 0. 05). Conclusion Carboprost tromethamine combined with oxytocin in the treatment of parturients with bleeding after caesarean section can help reduce postoperative bleeding and promote uterine involution,with accurate results and reliable safety.