卡前列素氨丁三醇、缩宫素联合子宫按摩对宫缩乏力性产后出血患者止血效果、脂质过氧化反应及凝血功能的影响

Effect of carboprost tromethamine,oxytocin combined with uterine massage on hemostatic lipid peroxidation reaction,and coagulation function in patients with postpartum hemorrhage caused by uterine atony

目的探究卡前列素氨丁三醇、缩宫素联合子宫按摩对宫缩乏力性产后出血患者止血效果、脂质过氧化反应及凝血功能的影响。方法回顾性选取2019年6月至2022年6月唐山市妇幼保健院妇产科收治的98例宫缩乏力性产后出血患者为研究对象,按照患者采取治疗方式不同将其分为观察组和对照组,每组各49例。对照组给予缩宫素+子宫按摩治疗,观察组在对照组的基础上联合给予卡前列氨丁三醇治疗。比较两组患者的出血情况(产后2、24 h的出血量、出血时间和出血发生率)、术后立即和术后24 h的脂质过氧化反应指标[谷胱甘肽过氧化物酶(GSH-px)、丙二醛、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)]、凝血指标[纤维蛋白原(FIB)、D-二聚体、活化部分凝血活酶时间(APTT)]、疗效及不良反应发生情况。结果观察组患者产后2 h、产后24 h出血量、止血时间及产后出血发生率分别为(207.85±22.74)mL、(319.34±35.71)mL、(14.97±2.86)min、4.08%,均显著低于对照组[(307.92±49.44)mL、(429.48±51.37)mL、(28.54±3.57)min、12.24%],差异均有统计学意义(P<0.05)。观察组患者产后24 h的丙二醛水平为(6.21±1.21)μmol/L,显著低于对照组[(8.92±1.69)μmol],SOD、GSH-px、CAT水平分别为(421.45±48.35)U/L、(456.23±53.21)nmol/L、(377.88±47.18)U/L,均显著高于对照组[(324.39±41.17)U/L、(377.23±39.45)nmol/L、(321.42±38.21)U/L],差异均有统计学意义(P<0.05)。观察组产后24 h的FIB、D-二聚体、ATPP水平分别为(3.21±0.11)μmol/L、(1.23±53.21)mg/L、(26.94±3.01)s,均显著低于对照组[(4.23±0.69)μmol/L、(2.73±0.25)mg/L、(34.96±3.22)s],差异均有统计学意义(P<0.05)。观察组总有效为100.00%,高于对照组(83.67%),差异有统计学意义(P<0.05)。观察组患者不良反应发生率为12.24%,显著低于对照组(22.45%),差异有统计学意义(P<0.05)。结论卡前列素氨丁三醇、缩宫素联合子宫按摩可提高宫缩乏力性产后出血患者止血效果,有效改善患者脂质过氧化反应和凝血功能,且安全性高,具有临床推广应用价值。

Objective To investigate effect of carboprost tromethamine and oxytocin combined with uterine massage on the hemostatic lipid peroxidation reaction,and coagulation function in patients with postpartum hemorrhage caused by uterine atony.Methods A total of 98 postpartum hemorrhage caused by uterine atony admitted to the Department of Obstetrics and Gynecology of Tangshan Maternal and Child Health Hospital from June 2019 to June 2022 were retrospectively selected as the objects of this study.According to different treatment methods,the patients were divided into the observation group and the control group,49 cases in each group.The control group received treatment with oxytocin and uterine massage,while the observation group received combined treatment with carboprost tromethamine on the basis of the control group.The bleeding status(bleeding volume at 2 and 24 hours postpartum,bleeding time,and bleeding incidence),serum lipid peroxidation reaction indicators[glutathione peroxidase(GSH-px),malondialdehyde,superoxide dismutase(SOD),catalase(CAT)],coagulation indicators[fibrinogen(FIB),D-dimer,activated partial thromboplastin time(APTT)]immediately and 24 hours postpartum,efficacy,and incidence of adverse reactions were compared between two groups of patients.Results The bleeding volume at 2 and 24 hours postpartum,bleeding time,and bleeding incidence in observation group were(207.85±22.74)mL,(319.34±35.71)mL,(14.97±2.86)min,and 4.08%,respectively,which were significantly lower than those in control group[(307.92±49.44)mL and(429.48±51.37)mL,(28.54±3.57)min,12.24%],and the differences were statistically significant(P<0.05).The level of MDA in the observation group at 24 hours postpartum was(6.21±1.21)μmol/L,which was significantly lower than that in the control group[(8.92±1.69)μmol/L],the levels of SOD,GSH-px and CAT in the observation group were(421.45±48.35)U/L,(456.23±53.21)nmol/L,(377.88±47.18)U/L,respectively,which were significantly higher than those in the control group[(324.39±41.17)U/L,(377.23±39.45)nmol/L,(321.42±38.21)U/L],and the differences were statistically significant(P<0.05).The levels of FIB,D-Dimer and ATPP in the observation group at 24 h postpartum were(3.21±0.11)μmol/L,(1.23±53.21)mg/L,(26.94±3.01)s,respectively,which were significantly lower than those in the control group[(4.23±0.69)μmol/L,(2.73±0.25)mg/L,(34.96±3.22)s],and the differences were statistically significant(P<0.05).The total effective rate of the observation group was 100.00%,which was higher than that of the control group(83.67%),and the difference was statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 12.24%,which was significantly lower than that in the control group(22.45%),and the difference was statistically significant(P<0.05).Conclusion The combination of carboprost tromethamine and oxytocin combined with uterine massage improves the hemostatic effect of postpartum hemorrhage caused by uterine atony,effectively improves lipid peroxidation and coagulation function in patients,and has high safety.It has clinical promotion and application value.