马来酸麦角新碱和缩宫素促进产后子宫复旧的临床研究

Clinical trial of ergometrine maleate combined1withooxytocin in promoting postpartum uterine involution

目的 比较马来酸麦角新碱注射液联合缩宫素注射液和单用缩宫素注射液用于子宫复旧,预防继发性产后出血的临床疗效及安全性。方法 将经阴道分娩且无并发症的产妇按用药方法分为试验组和对照组。试验组在第3产程胎盘娩出后,立即静脉滴注缩宫素20 U,肌内注射马来酸麦角新碱0.2 mg;产后2 h肌内注射马来酸麦角新碱0.2 mg;产后24 h肌内注射马来酸麦角新碱0.2 mg。对照组在第3产程胎盘娩出后立即静脉滴注缩宫素20 U;产后2 h肌内注射缩宫素20 U;产后24 h静脉滴注缩宫素20 U。比较2组产妇的产后恶露量及恶露持续的时间,以及药物不良反应的发生情况。结果 共纳入226例患者,其中,试验组95例、对照组131例。试验组产后2~24 h和产后24~48 h的恶露量分别为(65.11±45.18)和(31.73±17.80)mL,均明显少于对照组的(109.33±75.97)和(56.01±33.81)mL,恶露持续时间明显短于对照组[(10.48±7.71)vs(12.47±7.76)min],差异均有统计学意义(均P<0.05)。产妇出院时,试验组和对照组产妇用药后子宫体积分别为(265.17±204.65)和(319.17±214.57) mm^(3),差异有统计学意义(P<0.05)。2组均观察到部分产妇在应用宫缩药后出现药物不良反应,主要有高血压、头痛、恶心、呕吐。试验组和对照组的总药物不良反应发生率分别为0.10%和0.70%,2组相似。结论 2种方法均可以促进产妇子宫复旧,与单用缩宫素比较,马来酸麦角新碱联合缩宫素在减少药物不良反应上无明显优势,但在促进子宫收缩,加强子宫复旧上存在一定的优势。

Objective To compare the clinical efficacy and safety of ergometrine maleate combined with oxytocin and oxytocin alone in the treatment of uterine involution and prevention of secondary postpartum bleeding.Methods The parturients who delivered through vaginal delivery without complications were divided into treatment and control groups.In the treatment group,oxytocin 20 U was intravenously given and ergometrine maleate 0.2 mg was intramuscularly given immediately after the third stage of labor;followed by intramuscular injection of ergometrine maleate 0.2 mg 2 hours after delivery and intramuscular injection of ergometrine maleate 0.2 mg 24 h after delivery.The control group immediately received intravenous infusion of oxytocin 20 U after placenta delivery in the third stage of labor,followed by intramuscular injection of oxytocin 20 U 2 hours postpartum and intravenous infusion of oxytocin 20 U 24 hours postpartum.The amount of postpartum lochia,the duration of lochia and the occurrence of adverse drug reaction were compared between two groups.Results A total of226 patients were included,including 95 cases in the treatment group and 131 cases in the control group.Lochia volumes at 2 to 24 h and 24 to 48 h postpartum in the treatment group were(65.11±45.18)and(31.73±17.80)mL,significantly lower than those of control group[(109.33±75.97)and(56.01±33.81)mL];the duration was significantly shorter than that of control group[(10.48±7.71)vs(12.47±7.76)min],and the differences were statistically significant(all P<0.05).At the time of discharge,the uterine volumes of treatment and control groups were(265.17±204.65)and(319.17±214.57)mm^(3),and the difference was statistically significant(P<0.05).In both groups,adverse drug reactions were observed after the application of uterine contraction agent,mainly including hypertension,headache,nausea and vomiting.The incidences of adverse drug reaction in the treatment group and the control group were 0.10%and 0.10%,which were similar.Conclusion Both methods can promote uterine involution of parturient women.Compared with oxytocin,the combination of ergometrine maleate and oxytocin has no obvious advantage in reducing adverse drug reaction,but it has certain advantages in promoting uterine contraction and promoting uterine involution.