卡前列素氨丁三醇联合宫腔球囊放置术治疗59例前置胎盘产后出血患者的临床有效性及对凝血功能的影响分析

Clinical efficacy of carboprost tromethamine combined with intrauterine balloon placement in the treatment of 59 cases of postpartum hemorrhage due to placenta previa and its influence on blood coagulation function

目的探讨卡前列素氨丁三醇联合宫腔球囊放置术治疗前置胎盘产后出血患者的临床疗效及对凝血功能的影响。方法选择青海红十字医院2020年1月-2022年12月收治的59例患者,随机将其分为观察组(n=30)和对照组(n=29)。对照组采用宫腔球囊放置术治疗,观察组在此基础上联合卡前列素氨丁三醇治疗。观察比较两组临床疗效、凝血功能(PT、APTT、TT、FIB)、不同时间点出血量(产时、产后2h、24h)、宫缩持续时间、恶露持续时间、宫底下降速度及不良反应发生情况。结果观察组有效率为93.33%,明显高于对照组的75.86%(Z=-2.787,P=0.005)。治疗后,两组患者PT、APTT、TT及FIB与治疗前比较均下降(P<0.05);且观察组各项指标明显低于对照组(t=-9.494,P=0.000;t=-5.348,P=0.000;t=-4.219,P=0.000;t=-7.844,P=0.000)。观察组产后各个时间点出血量均少于对照组(t=-11.432,P=0.000;t=-6.625,P=0.000);组内比较,两组产后2h、产后24h出血量均明显多于产时出血量(P<0.05);且产后24h出血量多于产后2h出血量(P<0.05)。观察组宫缩持续时间(3.54±0.67)h,长于对照组的(1.89±0.42)h(t=11.374,P=0.000);宫底下降速度(1.78±0.35)cm/d,优于对照组的(0.92±0.17)cm/d(t=12.066,P=0.000);恶露持续时间较对照组更短(13.05±1.12)dVS(18.47±1.36)d(t=-16.679,P=0.000)。两组不良反应发生率比较,无统计学差异(χ^(2)=1.135,P=0.287)。结论卡前列素氨丁三醇联合宫腔球囊放置术治疗前置胎盘产后出血临床疗效显著,可有效改善患者凝血功能,减少出血量,促进宫缩并加快宫底下降速度,减少恶露时间,安全性高,值得临床推荐。

Objective This study aims to investigate the clinical efficacy of carboprost tromethamine combined with intrauterine balloon implantation in the treatment of postpartum hemorrhage due to placenta previa and its influence on blood coagulation function.Method This study 59 patients admitted to our hospital from January 2020 to December 2022 and randomly divided into an observation group(n=30)and control group(n=29).The control group was treated with intrauterine balloon placement,and the observation group was treated with carboprost tromethamine on this basis.It observed and compared the clinical efficacy,coagulation function(PT.APTT,TT,FIB),bleeding volume at different time points(during labor,2 hours postpartum,24 hours postpartum),duration of uterine contraction,duration of lochia,rate of uterine floor descent,and incidence of adverse reaction between the two groups.Result The effective rate of the observation group was 93.33%,significantly higher than that of 75.86%the control group(Z=-2.787,P=0.005).After treatment,PT,APTT,TT,and FIB in both groups of patients decreased compared to before treatment(P<0.05).And,all indicators in the observation group were significantly lower than those in the control group(t=-9.494,P=0.000;t=-5.348,P=0.000;t=-4.219,P=0.000;t=-7.844,P=0.000).The amount of postpartum bleeding in the observation group at various time points was less than that in the control group(t=-11.432,P=0.000;t=-6.625,P=0.000).Compared within the group,the bleeding volume at 2 and 24 hours postpartum in both groups was significantly more than that during childbirth(P<0.05).And,the amount of bleeding at 24 hours postpartum was more than that at 2 hours postpartum(P<0.05).The duration of uterine contraction in the observation group was(3.54±0.67)hours,which was longer than that of(1.89±0.42)hours in the control group(t=11.374,P=0.000).The descent rate of the uterine fundus was(1.78±0.35)cm/d,which was better than that of(0.92±0.17)cm/d in the control group(t=12.066,P=0.000).The duration of lochia was shorter than that of the control group(13.05±1.12)days vs(18.47±1.36)days(t=-16.679,P=0.000).There was no statistically significant difference in the incidence of adverse reaction between the two groups(χ^(2)=1.135,P=-0.287).Conclusion Carboprost tromethamine combined with intrauterine balloon placement has a significant clinical effect in the treatment of postpartum hemorrhage of placenta previa.It effectively improves the coagulation function of patients,reduces the amount of bleeding,promotes the rate of uterine contraction and fundus decline,reduces the discharge of lochia.With the high safety,it is worthy of clinical recommendation.