低分子肝素钠在改善子宫动脉栓塞术治疗产时出血术后并发症中的应用

Clinical study on the application of low molecular weight heparin sodium in improving postoperative complications after intrapartum hemorrhage treated with uterine artery embolization

目的:探究子宫动脉栓塞术(uterine artery embolization,UAE)治疗产时出血后应用低分子肝素钠改善栓塞术后并发症的效果。方法:选取2017年8月至2020年8月青岛市胶州中心医院应用UAE治疗产时出血的患者70例,均分为实验组与对照组。对照组术后不使用药物抗凝治疗,实验组术后使用低分子肝素钠治疗。利用视觉模拟评分(Visual Analogue Scale,VAS)对两组术后72 h内疼痛感进行比较,比较两组阴道出血量;对2组术后6个月月经情况进行比较;利用简易健康测量量表(Short-Form Health Surve-36,SF-36)对两组术后生活质量进行比较;对两组术后并发症产生情况进行比较。结果:实验组治疗后24、48、72 h的VAS评分分别为6.40±0.42、3.16±0.40、1.58±0.19,阴道出血量分别为(224.25±23.85)mL、(132.25±14.77)mL、(54.10±5.39)mL;对照组治疗后24、48、72 h的VAS评分分别为6.79±0.71、4.15±0.52、2.65±0.27,阴道出血量分别为(271.51±24.68)mL、(198.12±20.04)mL、(79.98±9.32)mL,两组相比差异均有统计学意义(均P<0.05);实验组转经时间、恶露暴露时间、月经周期分别为(91.55±10.76)d、(29.58±2.99)d、(29.40±2.76)d,明显低于对照组的(98.35±11.45)d、(34.32±2.69)d、(32.48±3.05)d,经量正常比例为85.71%,明显高于对照组的62.86%,差异有统计学意义(P<0.05);实验组术后6个月SF-36评分总分为(169.19±18.42)分,明显高于对照组的(160.57±16.58)分,差异有统计学意义(P<0.05);实验组术后并发症发生率为8.57%,明显低于对照组的28.57%,差异有统计学意义(P<0.05)。结论:UAE治疗产时出血后应用低分子肝素钠可减轻患者腹痛症状,减少阴道出血量及月经异常发生率,提高患者术后生活质量,具有良好的临床应用价值。

Objective:To explore the application effect of low molecular weight heparin(LMWH)sodium in improving postoperative complications after intrapartum hemorrhage treated with uterine artery embolization(UAE).Methods:A total of 70 patients with intrapartum hemorrhage undergoing UAE in the hospital from August 2017 to August 2020 were enrolled and divided into an experimental group and a control group,35 cases in each group.After surgery,control group was not given drugs for anti-coagulation treatment,while experimental group was treated with LMWH sodium.The pain within 72 h after surgery and the vaginal blood loss were compared between the 2 groups by Visual Analogue Scale(VAS).Menstruation at 6 months after surgery was compared between the 2 groups.The postoperative quality of life was compared between the 2 groups by Short-Form Health Surve-36(SF-36).Besides,the occurrence of postoperative complications was compared between the 2 groups.Results:The VAS scores of the experimental group were 6.40±0.42,3.16±0.40,1.58±0.19 at 24 h,48 h and 72 h after treatment,respectively,and the volume of vaginal bleeding was(224.25±23.85)mL,(132.25±14.77)mL,(54.10±5.39)mL,respectively;VAS scores of control group 24,48 and 72 h after treatment were 6.79±0.71,4.15±0.52,2.65±0.27,and vaginal bleeding was(271.51±24.68)mL,(198.12±20.04)mL,(79.98±9.32)mL,respectively.There were statistically significant differences between the two groups(all P<0.05).The menstruation time,lochia exposure time and menstrual cycle in the experimental group were(91.55±10.76)d,(29.58±2.99)d and(29.40±2.76)d,significantly shorter than those in the control group[(98.35±11.45)d,(34.32±2.69)d,(32.48±3.05)d],while the proportion of patients with normal menstrual volume was significantly higher than that in the control group(85.71%vs 62.86%,P<0.05).At 6 months after surgery,total score of SF-36 in the experimental group was significantly higher than that in the control group[(169.19±18.42)points vs(160.57±16.58)points](P<0.05),while the incidence of postoperative complications was significantly lower than that in the control group(8.57%vs 28.57%,P<0.05).Conclusion:The application of LMWH sodium after intrapartum hemorrhage treated with UAE can alleviate abdominal pain,reduce vaginal blood loss and the incidence of abnormal menstruation,and improve patients’postoperative quality of life.