卡前列素氨丁三醇联合低位B-Lynch缝合术在难治性前置胎盘产后出血的应用分析

Application Analysis of Carboprost Tromethamine Combined with Low B-Lynch Suture in Refractory Placenta Previa Postpartum Hemorrhage

目的:分析卡前列素氨丁三醇联合低位子宫背带式(B-Lynch)缝合术在难治性前置胎盘产后出血产妇中的应用价值。方法:选取2018年4月至2020年5月河南省直第三人民医院难治性前置胎盘产后出血产妇68例,按随机数字表法分为研究组(n=34)与对照组(n=34),均行剖宫产术,对照组采用缩宫素联合“8”字间断缝合术,研究组采用卡前列素氨丁三醇联合低位B-Lynch缝合术,对比两组临床效果、围术期情况(术中出血量、术后24 h出血量、止血时间、下床活动时间、住院时间)、并发症发生率、子宫切除率,对比两组手术结束即刻、术后24 h凝血功能[纤维蛋白原(FIB)、D-二聚体(D-D)]变化。结果:研究组总有效率94.12%(32/34)较对照组73.53%(25/34)高,差异有统计学意义(P<0.05);研究组术中出血量、术后24 h出血量较对照组少,止血时间、下床活动时间、住院时间较对照组短,差异有统计学意义(P<0.05);手术结束即刻、术后24 h研究组FIB、D-D水平均较对照组低,差异有统计学意义(P<0.05);研究组并发症发生率2.94%(1/34)与对照组14.71%(5/34)相比差异无统计学意义(P>0.05);研究组子宫切除率2.94%(1/34)与对照组11.76%(4/34)相比差异无统计学意义(P>0.05)。结论:卡前列素氨丁三醇联合低位B-Lynch缝合术应用于难治性前置胎盘产后出血效果显著,可避免切除子宫,且并发症发生率低。

Objective:To analyze the application value of carboprost tromethamine combined with low B-Lynch suture in refractory placenta previa postpartum hemorrhage.Methods:A total of 68 women with refractory placenta previa postpartum hemorrhage in the Third People's Hospital of Henan from April 2018 to May 2020 were selected and divided into study group(n=34)and control group(n=34)according to the random number table method,both given cesarean section.The control group used oxytocin combined with"8"intermittent suture,and the study group used carboprost tromethamine combined with low B-Lynch suture.The clinical effects,perioperative conditions(intraoperative blood loss,24 h postoperative blood loss,time to hemostasis,time to get out of bed,length of hospital stay),complication rate,and hysterectomy rate were compared between the two groups.The coagulation function(FIB,D-D)changes immediately after the operation and 24 hours after the operation were compared between the two groups.Results:The total effective rate of the study group was 94.12%(32/34),higher than that of the control group 73.53%(25/34)(P<0.05).The amount of bleeding during operation and 24 h after operation in the study group was less than that of the control group,and the time to stop bleeding,time to get out of bed,and hospital stay were shorter than those in the control group(P<0.05).The FIB and DD levels of the study group immediately after the operation and 24 hours after the operation were lower than those of the control group(P<0.05).The complication rate in the study group was 2.94%(1/34),which was no significant difference compared with 14.71%(5/34)in the control group(P>0.05).The hysterectomy rate in the study group was 2.94%(1/34),which was no significant difference compared with 11.76%(4/34)in the control group(P>0.05).Conclusion:Carboprost tromethamine combined with low-level B-Lynch suture is effective in the treatment of intractable postpartum hemorrhage of placenta previa,can avoid hysterectomy,and the incidence of complications is low.