子宫动脉下行支结扎术结合缩宫素治疗宫缩乏力性产后出血的效果

Effect of ligation of descending branch of uterine artery combined with oxytocin on postpartum hemorrhage caused by uterine inertia

目的探讨子宫动脉下行支结扎术结合缩宫素治疗宫缩乏力性产后出血的临床效果。方法选取我院收治的106例宫缩乏力性产后出血患者为研究对象,根据治疗方式将患者分为观察组和对照组。对照组50例患者单纯应用缩宫素治疗,观察组56例患者应用缩宫素结合子宫动脉下行支结扎及宫旁血管钳夹术治疗。比较2组患者的围术期情况、出血情况、术后月经情况、血清性激素水平及并发症情况;评估2组患者产前、产后24 h凝血功能指标变化情况;评价并比较2组患者生产前后的性生活质量。结果与对照组比较,观察组手术时间更长,且术中及产后12 h、24 h的出血量更少,止血时间、下床活动时间及住院时间均更短,子宫切除率更低(P<0.05)。2组患者术后月经情况及术后6个月的雌二醇(E2)、促卵泡素(LH)和促黄体素(FSH)水平比较差异均无统计学意义(P>0.05)。观察组并发症总发生率低于对照组(P<0.05)。对照组产后24 h的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)水平长/低于观察组(P<0.05)。观察组患者产后6个月性功能指标均优于对照组(P<0.05)。结论缩宫素结合子宫动脉下行支结扎术治疗宫缩乏力性产后出血的止血效果好,且能保留子宫,不影响产后激素分泌,减小凝血功能指标波动,有效提高患者的性生活质量。

Objective To investigate the effect of ligation of descending branch of uterine artery combined with oxytocin in the treatment of postpartum hemorrhage caused by uterine inertia.Methods A total of 106 patients with postpartum hemorrhage caused by uterine inertia in our hospital were selected as the research objects,and they were divided into the observation group and the control group according to the treatment methods.Fifty patients in the control group were treated with oxytocin alone,and 56 patients in the observation group were treated with parauterine vascular clipping and ligation of descending branch of uterine artery combined with oxytocin.The perioperative conditions,bleeding conditions,postoperative menstruation,serum sex hormone levels and complications of the two groups were compared.The changes of coagulation function indexes before delivery and 24 hours after delivery of the two groups were evaluated,and the quality of sexual life before and after delivery of the two groups were evaluated and compared.Results Compared with the control group,the operation time in the observation group was longer,and the amount of bleeding during operation,12 hours and 24 hours after delivery were less,the time of getting out of bed,hemostasis and hospitalization were shorter,and the hysterectomy rate was lower(P<0.05).There was no significant difference in the postoperative menstruation or the levels of estradiol(E2),luteinizing hormone(LH)and follicle stimulating hormone(FSH)6 months after surgery between the two groups(P>0.05).The total incidence of complications in the observation group was lower than that in the control group(P<0.05).The prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB)24 hours after delivery in the control group were longer/lower than those in the observation group(P<0.05).The indexes of sexual function 6 months after delivery in the observation group were significantly better than those in the control group(P<0.05).Conclusion Oxytocin combined with ligation of descending branch of uterine artery has a good hemostatic effect in the treatment of postpartum hemorrhage caused by uterine inertia,and can preserve the uterus without affecting postpartum hormone secretion,reduce the fluctuation of coagulation function index and effectively improve the quality of sexual life of patients.