马来酸麦角新碱联合缩宫素、米索前列醇预防二次剖宫产产后出血的效果及对血流动力学的影响

Effect of ergometrine maleate combined with oxytocin and misoprostol in preventing postpartum hemorrhage after secondary cesarean section and its influence on hemodynamics

目的探讨马来酸麦角新碱联合缩宫素、米索前列醇预防二次剖宫产产后出血的效果及对血流动力学的影响。方法择取2019年1月至2022年12月收治的160名二次剖宫产产妇为研究对象,将其随机分为对照组、观察组,各80名。对照组采用缩宫素、米索前列醇治疗,观察组在对照组基础上加用马来酸麦角新碱治疗。比较两组的应用效果。结果观察组的术后2、24 h出血量少于对照组,止血时间、恶露持续时间短于对照组,差异具有统计学意义(P<0.05)。治疗前,两组的子宫动脉收缩期峰值血流速度(PSV)、阻力指数(RI)及搏动指数(PI)比较,差异无统计学意义(P>0.05);治疗后,观察组的子宫动脉PSV低于对照组,RI、PI高于对照组,差异具有统计学意义(P<0.05)。治疗前,两组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及D-二聚体(D-D)、纤维蛋白原(FIB)水平比较,差异无统计学意义(P>0.05);治疗后,观察组的PT、APTT短于对照组,D-D水平低于对照组,FIB水平高于对照组,差异具有统计学意义(P<0.05)。结论马来酸麦角新碱联合缩宫素、米索前列醇对二次剖宫产产后出血的预防效果良好,不仅能够改善血流动力学,还能提高凝血功能,减少术后出血症状,值得推广。

Objective To investigate the effect of ergometrine maleate combined with oxytocin and misoprostol in preventing postpartum hemorrhage after secondary cesarean section and its influence on hemodynamics.Methods From January 2019 to December 2022,160 pregnant women with secondary cesarean section were selected as the research objects,and the pergnant women were randomly divided into control group and observation group,with 80 cases in each group.The control group was treated with oxytocin and misoprostol,and the observation group was treated with ergometrine maleate on the basis of the control group.The thevapeutic effects of the two groups were compared.Results The amount of bleeding at 2 and 24 h after operation in the observation group was less than that in the control group,and the hemostasis time and duration of lochia were shorter than those in the control group,and the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in uterine artery peak systolic velocity(PSV),resist index(RI)and pulsatility index(PI)between the two groups(P>0.05);after treatment,the uterine artery PSV of the observation group was lower than that of the control group,and the RI and PI were higher than those of the control group,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D)and fibrinogen(FIB)levels between the two groups(P>0.05);after treatment,the PT and APTT of the observation group were shorter than those of the control group,the D-D level was lower than that of the control group,and the FIB level was higher than that of the control group,the differences were statistically significant(P<0.05).Conclusion Ergometrine maleate combined with oxytocin and misoprostol has a good preventive effect on postpartum hemorrhage after secondary cesarean section.It can not only ameliorate hemodynamics,but also improve coagulation function and reduce postoperative bleeding symptoms.It is worth promoting.