葡萄糖酸钙与氨甲环酸联合麦角新碱对产后出血患者凝血功能的影响

Effect of calcium gluconate and tranexamic acid combined with ergometrine on coagulation function in patients with postpartum hemorrhage

目的观察葡萄糖酸钙与氨甲环酸联合麦角新碱治疗对产后出血患者凝血功能的影响。方法回顾性选取2020年1月—2023年12月选取厦门大学附属第一医院妇产科收治的产后出血患者150例,按照治疗方式不同分为单一注射组(给予马来酸麦角新碱注射液治疗)和联合注射组(在单一注射组基础上给予葡萄糖酸钙注射液与氨甲环酸注射液),各75例。比较2组临床疗效,不同时点(胎盘娩出即刻与分娩后2、24 h)出血量,分娩前与分娩12 h后凝血功能指标[凝血酶原时间(PT)、纤维蛋白原(Fib)、活化部分凝血活酶时间(APTT)]与血红蛋白(Hb)水平,不良反应。结果联合注射组治疗总有效率高于单一注射组(98.67%vs.89.33%,χ^(2)=4.225,P=0.039)。联合注射组胎盘娩出即刻与分娩后2、24 h出血量均少于单一注射组(P<0.01)。分娩12 h后,2组PT、APTT短于分娩前,Fib水平高于分娩前,Hb水平低于分娩前,且联合注射组上述指标改善幅度优于单一注射组(P<0.01)。联合注射组与单一注射组不良反应总发生率比较,差异无统计学意义(4.00%vs.6.67%,χ^(2)=0.132,P=0.716)。结论葡萄糖酸钙与氨甲环酸联合麦角新碱治疗产后出血的效果良好,可有效减少出血量,改善凝血功能,具有良好的安全性。

Objective To observe the effect of calcium gluconate and tranexamic acid combined with ergometrine on coagulation function in patients with postpartum hemorrhage.Methods A total of 150 patients with postpartum hemorrhage who were admitted to the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Xiamen University from January 2020 to December 2023 were retrospectively selected and divided into the single injection group(treated with ergometrine maleate injection)and the combined injection group(calcium gluconate injection and tranexamic acid injection on the basis of the single injection group)by different treatment method,with 75 cases in each group.The clinical efficacy,the amount of blood loss at different time points(immediately after delivery of the placenta and 2 and 24 h after delivery),the coagulation function indexes(PT,Fib,APTT)and Hb level before and after 12 h of delivery,and adverse reactions were compared between the two groups.Results The total effective rate of treatment in the combined injection group was higher than that in the single injection group(98.67%vs.89.33%,χ2=4.225,P=0.039).The amount of blood loss in the combined injection group immediately after delivery and at 2,24 h after delivery were lower than those in the single injection group(P<0.01).After 12 h of delivery,PT and APTT in the two groups were shorter than those before delivery,the Fib level was higher than that before delivery,and the Hb level was lower than that before delivery,and the improvement of the above indexes in the combined injection group were better than those in the single injection group(P<0.01).There was no significant difference in the total incidence of adverse reactions between the combined injection group and the single injection group(4.00%vs.6.67%,χ2=0.132,P=0.716).Conclusion Calcium gluconate and tranexamic acid combined with ergometrine have good effect in the treatment of postpartum hemorrhage,which can effectively reduce blood loss,improve coagulation function,and have a good safety profile.