宫腔球囊填塞术联合卡前列素氨丁三醇-米索前列醇治疗剖宫产后宫缩乏力性产后出血的效果及对子宫血流动力学指标的影响

Effect of intrauterine balloon tamponade combined with carboprost tromethamine-misoprostol in the treatment of postpartum hemorrhage caused by uterine inertia after cesarean section and its influences on uterine hemodynamic indexes

目的探究宫腔球囊填塞术联合卡前列素氨丁三醇-米索前列醇治疗剖宫产后宫缩乏力性产后出血的效果。方法选择2020年2月至2023年3月收治的80例剖宫产后宫缩乏力性产后出血患者为研究对象,以随机数字表法将其分为对照组和观察组,各40例。对照组接受卡前列素氨丁三醇-米索前列醇治疗,观察组在对照组基础上加施宫腔球囊填塞术。比较两组的治疗效果相关指标、子宫血流动力学指标及凝血功能指标。结果观察组的止血成功率高于对照组,子宫复旧不全发生率及再发出血率均低于对照组,差异具有统计意义(P<0.05)。治疗后,观察组的子宫动脉舒张末期血流速度(EDV)、收缩期峰值血流速度(PSV)高于对照组,阻力指数(RI)、搏动指数(PI)低于对照组,差异具有统计意义(P<0.05)。治疗后,观察组的纤维蛋白原(Fib)水平高于对照组,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)短于对照组,差异具有统计意义(P<0.05)。结论宫腔球囊填塞术联合卡前列素氨丁三醇-米索前列醇治疗剖宫产后宫缩乏力性产后出血患者可改善机体凝血功能,调节子宫血流动力学指标,提高整体疗效,值得在临床中推广及应用。

Objective To explore the effect of intrauterine balloon tamponade combined with carboprost tromethamine-misoprostol in the treatment of postpartum hemorrhage caused by uterine inertia after cesarean section.Methods A total of 80 patients with postpartum hemorrhage caused by uterine inertia after cesarean section admitted from February 2020 to March 2023 were selected as the research objects,and the patients were divided into control group and observation group by random number table method,with 40 cases in each group.The control group was treated with carboprost tromethamine-misoprostol,and the observation group was treated with intrauterine balloon tamponade on the basis of the control group.The therapeutic effect related indexes,uterine hemodynamics indexes and coagulation function indexes of the two groups were compared.Results The success rate of hemostasis in the observation group was higher than that in the control group,the incidence of incomplete uterine involution and the rate of rebleeding were lower than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the end diastolic velocity(EDV)and peak systolic velocity(PSV)of uterine artery in the observation group were higher than those in the control group,the resistance index(RI)and pulsatility index(PI)were lower than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the level of fibrinogen(Fib)in the observation group was higher than that in the control group,the prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)were shorter than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The intrauterine balloon tamponade combined with carboprost tromethamine-misoprostol in the treatment of patients with postpartum hemorrhage caused by uterine inertia after cesarean section can improve the body's coagulation function,regulate uterine hemodynamic indexes,improve the overall efficacy,which is worthy of promotion and application in chinical practice.