氨甲环酸联合卡贝缩宫素预防前置胎盘产后出血及对应激反应和卵巢储备功能的影响

Efficacy of tranexamic acid combined with carbetocin in preventing placenta previa induced PPH and its impact on stress response and ovarian reserve function

目的 探讨氨甲环酸联合卡贝缩宫素预防前置胎盘产后出血(PPH)及其对应激反应和卵巢储备功能的影响。方法 回顾性选择北京航天总医院2018年6月至2023年6月收治的85例前置胎盘产妇作为研究对象,采用数字表法分组,对照组采用卡贝缩宫素治疗(n=39),观察组采用卡贝缩宫素加氨甲环酸治疗(n=46),比较两组治疗后临床疗效、产后不同时间(产后0.5、2、12、24 h)出血量、持续出血时间、血流动力学、凝血功能、应激反应、卵巢储备功能、子宫恢复情况及并发症发生率。结果 总有效率观察组[95.65%(44/46)]高于对照组[74.36%(29/39)],差异有统计学意义(χ^(2)=7.892,P<0.05);产后0.5、2、12、24 h,观察组出血量[分别是(170.65±13.25) m L、(214.65±32.50) m L、(240.15±60.20) m L、(267.90±45.65) m L]均比对照组[分别是(181.52±14.20) m L、(235.50±34.60) m L、(290.15±55.60) m L、(385.66±50.255) m L]少,持续出血时间[(31.50±6.40) d)比对照组((40.15±6.35) d]短,差异均有统计学意义(均P<0.05);治疗后观察组心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)[分别是(82.80±4.12)次·min^(-1)、(116.80±5.20) mm Hg (1 mm Hg≈0.133 k Pa)、(80.50±5.05) mm Hg、(80.05±5.25) mm Hg]优于对照组[分别是(88.10±4.10)次·min^(-1)、(111.95±6.45) mm Hg、(76.60±5.10) mm Hg、(75.20±5.65) mm Hg],差异均有统计学意义(均P<0.05);治疗后24 h、72 h,观察组活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)(24 h分别是(37.00±4.15) s、(10.20±1.20) s;72 h分别是(32.51±3.95) s、(9.26±1.04) s)比对照组(24 h分别是(44.35±4.20) s、(13.80±1.25) s;72 h分别是(40.33±4.16) s、(11.18±1.13) s)低,纤维蛋白原(FIB)、D-二聚体(D-D)水平[24 h分别是(4.10±0.65) g·L^(-1)、(3.68±0.30) g·L^(-1);72 h分别是(4.68±1.15) g·L^(-1)、(3.97±0.48) g·L^(-1)]比对照组[24 h分别是(3.20±0.50) g·L^(-1)、(3.02±0.35) g·L^(-1);72 h分别是(3.70±1.10) g·L^(-1)、(3.36±0.51) g·L^(-1)]高,差异均有统计学意义(均P<0.05);治疗后,观察组肾上腺素(AD)、去甲肾上腺素(NE)、皮质醇(Cor)水平[分别是(50.20±5.80) pg·m L^(-1)、(294.85±29.10) pg·m L^(-1)、(290.85±26.55) ng·m L^(-1)]比对照组[分别是(68.75±6.50) pg·m L^(-1)、(350.98±32.90) pg·m L^(-1)、(350.90±28.65) ng·m L^(-1)]低,差异均有统计学意义(均P<0.05);产后3个月、产后6个月,观察组促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)、抗缪勒管激素(AMH)水平[3个月分别是(8.20±1.01) m IU m L^(-1)、(7.88±1.11) m IU m L^(-1)、(99.60±10.25) pg·m L^(-1)、(3.10±0.60) ng·m L^(-1);6个月分别是(7.85±1.12) m IU·m L^(-1)、(7.09±1.04) m IU·m L^(-1)、(91.53±8.77) pg·m L^(-1)、(2.87±0.45) ng·m L^(-1)]比对照组[3个月分别是(6.10±1.02) m IU·m L^(-1)、(6.35±0.98) m IU m L^(-1)、(90.20±12.30) pg·m L^(-1)、(2.70±0.52) ng·m L^(-1);6个月分别是(5.02±0.95) m IU·m L^(-1)、(4.81±0.79) m IU m L^(-1)、(83.26±7.59) pg·m L^(-1)、(2.13±0.41) ng·m L^(-1)]高,差异均有统计学意义(均P<0.05);观察组宫缩幅度、宫缩强度、宫缩张力[分别是(240.86±115.34) mm、(1 515.35±205.65) mm、(1 420.25±135.20) mm)比对照组(分别是(420.96±120.45) mm、(1 775.65±210.52) mm、(1 592.65±133.65) mm]小,差异均有统计学意义(均P<0.05);观察组并发症发生率(2.17%)比对照组(23.08%)低(χ^(2)=6.984,P<0.05)。结论 卡贝缩宫素加氨甲环酸能有效预防前置胎盘PPH,可保持血流动力学相对稳定,改善凝血功能,减轻应激反应,改善卵巢储备功能,还能促进子宫恢复,且并发症少,安全性高。

Objective To explore the effect of tranexamic acid combined with carbetocin on stress response and ovarian reserve function in the prevention of placenta previa induced postpartum hemorrhage.Methods A retrospective study was conducted on 85 pregnant women with placenta previa admitted to Beijing Aerospace General Hospital from June 2018 to June 2023.The patients in the control group(n=39)were treated with cabezol oxytocin while those in the observation group(n=46)with cabezol oxytocin and tranexamic acid. The clinical efficacy, postpartum bleeding volume at different time points (0.5, 2, 12, 24 h), duration of bleeding, hemodynamic indicators, coagulation function, stress response, ovarian reserve function, uterine recovery, and incidence of complications were compared between the two groups. Results The total effective rate of the observation group was higher than that of the control group (95.65% (44/46) vs 74.36% (29/39), χ^(2)=7.892, all P<0.05). At 0.5, 2, 12 and 24 h postpartum, the bleeding volume in the observation group was lower than that in the control group ((170.65±13.25) mL vs (181.52±14.20) mL, (214.65± 32.50) mL vs (235.50±34.60) mL, (240.15±60.20) mL vs (290.15±55.60) mL, (267.90±45.65) mL vs (385.66±50.255) mL), and the duration of bleeding was shorter than that in the control group ((31.50±6.40) d vs (40.15±6.35) d) (all P<0.05). After treatment, the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) of the observation group were better than those of the control group ((82.80±4.12) times·min^(-1) vs (88.10±4.10) times·min^(-1), (116.80±5.20) mm Hg (1 mm Hg≈0.133 kPa) vs (111.95±6.45) mm Hg, (80.50±5.05) mm Hg vs (76.60±5.10) mm Hg, (80.05±5.25) mm Hg vs (75.20±5.65) mm Hg, all P<0.05). After 24 and 72 hours of treatment, the activated partial thromboplastin time (APTT) and plasma prothrombin time (PT) of the observation group were lower than those of the control (24 h: (37.00±4.15) s vs (44.35±4.20) s, (10.20±1.20) s vs (13.80±1.25) s;72 h: (32.51± 3.95) s vs (40.33±4.16) s, (9.26±1.04) s vs (11.18±1.13) s), while the levels of fibrinogen (FIB) and D-dimer (D-D) were higher than those of the control (24 h: (4.10±0.65) g·L^(-1) vs (3.20±0.50) g·L^(-1), (3.68±0.30) g·L^(-1) vs (3.02±0.35) g·L^(-1);72 h: (4.68±1.15) g·L^(-1) vs (3.70±1.10) g·L^(-1), (3.97±0.48) g·L^(-1) vs (3.36±0.51) g·L^(-1)) (P<0.05). After treatment, the levels of adrenaline (AD), norepinephrine (NE) and cortisol (Cor) in the observation group were lower than those in the control ((50.20±5.80) pg·mL^(-1) vs (68.75±6.50) pg·mL^(-1), (294.85±29.10) pg·mL^(-1) vs (350.98±32.90) pg·mL^(-1), (290.85±26.55) ng·mL^(-1) vs (350.90±28.65) ng·mL^(-1)) (all P<0.05). At 3 and 6 months postpartum, the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Mullerian hormone (AMH) in the observation group were higher than those in the control (3 months: (8.20±1.01) mIU·mL^(-1) vs (6.10± 1.02) mIU·mL^(-1), (7.88±1.11) mIU·mL^(-1) vs (6.35±0.98) mIU·mL^(-1), (99.60±10.25) pg·mL^(-1) vs (90.20±12.30) pg·mL^(-1), (3.10± 0.60) ng·mL^(-1) vs (2.70±0.52) ng·mL^(-1);6 months: (7.85±1.12) mIU·mL^(-1) vs (5.02±0.95) mIU·mL^(-1), (7.09±1.04) mIU·mL^(-1) vs (4.81±0.79) mIU·mL^(-1), (91.53±8.77) pg·mL^(-1) vs (83.26±7.59) pg·mL^(-1), (2.87±0.45) ng·mL^(-1) vs (2.13±0.41) ng·mL^(-1)) (all P<0.05). The amplitude, intensity, and tension of contractions in the observation group were all smaller than those in the control ((240.86± 115.34) mm vs (420.96±120.45) mm, (1 515.35±205.65) mm vs (1 775.65±210.52) mm, (1 420.25±135.20) mm vs (1 592.65± 133.65) mm) (P<0.05). The incidence of complications in the observation group was lower than that in the control group (2.17% (1/46) vs 23.08% (9/39), χ^(2)=6.984, P<0.05). Conclusion Cabecycline combined with tranexamic acid can effectively prevent PPH in placenta previa, stabilize hemodynamics, improve coagulation function, alleviate stress response, improve ovarian reserve function, and promote uterine recovery with few complications and high safety.