双侧子宫动脉上行支结扎联合马来酸麦角新碱治疗剖宫产难治性产后出血的效果及对凝血因子水平的影响

Effect of bilateral ascending uterine artery ligation combined with ergometrine maleate in the treatment of intractable postpartum hemorrhage after cesarean section and its influences on coagulation factors levels

目的探讨双侧子宫动脉上行支结扎联合马来酸麦角新碱治疗剖宫产难治性产后出血的效果及对凝血因子水平的影响。方法选取2020年4月至2022年4月收治的80例剖宫产难治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与观察组,各40例。对照组给予马来酸麦角新碱治疗,观察组在对照组基础上加施双侧子宫动脉上行支结扎治疗。比较两组的治疗效果。结果观察组的治疗总有效率显著高于对照组(P<0.05)。治疗后,观察组的收缩期峰值流速(PSV)高于对照组,阻力指数(RI)、搏动指数(PI)低于对照组(P<0.05)。治疗后,观察组的凝血因子Ⅷ、Ⅸ、Ⅹ、ⅩⅢ高于对照组(P<0.05)。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(P<0.05)。结论双侧子宫动脉上行支结扎联合马来酸麦角新碱治疗剖宫产难治性产后出血的临床效果显著,可改善患者子宫血流动力学及凝血因子水平,促进凝血功能恢复,减少术后出血量,值得临床应用与推广。

Objective To investigate the effect of bilateral ascending uterine artery ligation combined with ergometrine maleate in the treatment of intractable postpartum hemorrhage after cesarean section and its influences on the coagulation factors levels.Methods A total of 80 patients with intractable postpartum hemorrhage after cesarean section admitted from April 2020 to April 2022 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 ergometrine maleate,and the observation group was treated with bilateral ascending uterine artery ligation on the basis of the control group.The therapeutic effects of the two groups were compared.Results The total effective rate of treatment in the observation group was significantly higher than that in the control group(P<0.05).After treatment,the peak systolic velocity(PSV)of the observation group was higher than that of the control group,and the resistance index(RI)and pulsatility index(PI)were lower than those of the control group(P<0.05).After treatment,the coagulation factorⅧ,Ⅸ,ⅩandⅩⅢin the observation group were higher than those in the control group(P<0.05).The amount of bleeding at 2 and 24 h after operation in the observation group were less than those in the control group,and the hemostasis time and duration of lochia were shorter than those in the control group(P<0.05).Conclusion The bilateral ascending uterine artery ligation combined with ergometrine maleate in the treatment of intractable postpartum hemorrhage after cesarean section has a significant clinical effect.It can improve the uterine hemodynamics and coagulation factors levels,promote the recovery of coagulation function,and reduce the amount of postoperative bleeding.It is worth applying and promoting in clinic.