麦角新碱联合缩宫素治疗产后出血的临床疗效及其对产妇凝血功能的影响

Clinical effect of ergometrine combined with oxytocin in the treatment of postpartum hemorrhage and the impact on coagulation function of puerpera

目的观察麦角新碱联合缩宫素治疗产后出血的临床疗效及其对产妇凝血功能的影响。方法回顾性选取2020年2月—2021年8月厦门市第五医院收治的产后出血产妇100例,依据用药方法分为单一用药组和联合用药组,各50例。单一用药组采用缩宫素治疗,联合用药组在单一用药组基础上予以麦角新碱治疗。比较2组临床疗效,产后1、2、4、24 h出血量,止血时间、胎盘娩出时间、宫缩持续时间、住院时间、恶露持续时间及追加宫缩剂、胎盘滞留、人工剥离胎盘、输血、子宫切除情况,用药前后收缩压、舒张压、心率、血流动力学指标(全血黏度、血浆黏度)、血常规[血红蛋白(Hb)、血细胞比容(HCT)、红细胞计数(RBC)]、凝血功能指标[纤维蛋白原(Fib)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)],不良反应发生情况。结果联合用药组治疗总有效率为96.00%,高于单一用药组的80.00%(χ^(2)=6.061,P=0.014)。联合用药组产后1、2、4、24 h出血量少于单一用药组(P<0.01)。联合用药组止血时间、胎盘娩出时间、住院时间、恶露持续时间短于单一用药组,宫缩持续时间长于单一用药组(P<0.01)。联合用药组输血率低于单一用药组(P<0.01);2组追加宫缩剂、胎盘滞留、人工剥离胎盘、子宫切除发生率比较,差异无统计学意义(P>0.05)。用药后2 h,2组收缩压、舒张压、心率及全血黏度、血浆黏度低于用药前,且联合用药组低于单一用药组(P<0.01)。用药后24 h,2组Hb、HCT、RBC高于用药前,且联合用药组高于单一用药组(P<0.01)。用药后2 d,2组血清Fib水平高于用药前,TT、PT、APTT短于用药前,且联合用药组血清Fib水平高于单一用药组,TT、PT、APTT短于单一用药组(P<0.01)。联合用药组不良反应总发生率为14.00%,与单一用药组的22.00%比较,差异无统计学意义(χ^(2)=1.084,P=0.298)。结论麦角新碱联合缩宫素治疗产后出血的效果较好,可快速减少出血量,降低输血率,缩短治疗时间,维持患者生命体征及血流动力学稳定,改善机体凝血功能,且安全性较高。

Objective To study the clinical effect of ergometrine combined with oxytocin in the treatment of postpartum hemorrhage and the impact on coagulation function of puerpera.Methods A total of 100 cases of puerpera with postpartum hemorrhage in Xiamen Fifth Hospital from February 2020 to August 2021 were retrospectively selected,and they were divided into single medication group and combined medication group according to medication method,with 50 cases in each group.Puerpera in single medication group were treated with oxytocin,puerpera in combined medication group were treated with ergometrine base on single medication group.Clinical effect,the amount of bleeding at 1,2,4 and 24 h after delivery,bleeding time,placenta delivery time,duration of contractions,length of hospital stay,duration of lochia,incidence of additional contractions,placental retention,artificial stripping the placenta,blood transfusions,hysterectomy,SBP,DBP,heart rate,hemodynamic indexes(whole blood viscosity,plasma viscosity),routine blood test(Hb,HCT,RBC),coagulation function indexes(Fib,TT,PT,APTT)before and after medicine,incidence of adverse reactions were compared between the two groups.Results Total effective rate of combined medication group was 96.00%,which was higher than 80.00%of single medication group(χ^(2)=6.061,P=0.014).The amount of bleeding at 1,2,4 and 24 h after delivery in combined medication group were less than those in single medication group(P<0.01).Bleeding time,placenta delivery time,length of hospital stay,duration of lochia in combined medication group were shorter than those in single medication group,duration of contractions was longer than that in single medication group(P<0.01).Incidence of blood transfusions of combined medication group was lower than that in single medication group(P<0.01);there was no significant difference of incidence of additional contractions,placental retention,artificial stripping the placenta,hysterectomy between the two groups(P>0.05).At 2 h after medicine,SBP,DBP,heart rate and whole blood viscosity,plasma viscosity in the two groups were lower than those before medicine,and those in combined medication group were lower than single medication group(P<0.01).At 24 h after medicine,Hb,HCT,RBC in the two groups were higher than those before medicine,and those in combined medication group were higher than single medication group(P<0.01).At 2 d after medicine,serum Fib level in the two groups was higher than that before medicine,TT,PT,APTT were shorter than those before medicine,and the serum Fib level in combined medication group was higher than that in single medication group,TT,PT,APTT were shorter than those in single medication group(P<0.01).There was no significant difference of the incidence of adverse reaction between combined medication group(1400%)and single medication group(22.00%)(χ^(2)=1.084,P=0.298).Conclusion Ergometrine combined with oxytocin have a better clinical effect in the treatment of puerperal hemorrhage,it can quickly reduce blood loss and blood transfusion rate,shorten treatment time,maintain patients′vital signs and hemodynamic stability,improve coagulation function,and with higher safety.