垂体后叶素与卡前列素氨丁三醇治疗胎盘剥离后大出血效果观察

Effect of pituitrin and carboprost tromethamine on massive hemorrhage after placental separation

目的 剥离胎盘是分娩过程中的一个重要环节,第三产程剥离胎盘时,由于胎盘剥离不全、胎盘滞留或嵌顿、胎盘植入及胎盘粘连等原因,可能引起剥离后大出血的情况。本研究观察垂体后叶素与卡前列素氨丁三醇治疗胎盘剥离后大出血的效果。方法 选择2017-02-01—2019-02-28南召县人民医院收治的56例胎盘剥离后大出血患者为研究对象,根据年龄、孕周和分娩方式选择研究组和对照组,各28例。对照组给予卡前列素氨丁三醇治疗,研究组加用垂体后叶素治疗。对比两组产后出血治疗效果、产后出血量、第三产程时间、血红蛋白含量及不良反应发生情况。结果 对照组产后出血治疗有效率为78.57%,低于研究组的96.43%,差异有统计学意义,χ~2=4.082,P=0.043。研究组产后1h出血量为(255.47±20.43)mL,低于对照组的(292.74±30.16)mL,t=11.115,P<0.001;产后3h出血量为(276.57±18.67)mL,低于对照组的(307.73±35.08)mL,t=9.895,P<0.001;产后24h出血量为(290.51±17.43)mL,低于对照组的(355.75±32.10)mL,t=10.257,P<0.001;第三产程时间为(20.67±1.04)min,短于对照组的(26.59±1.12)min,t=5.886,P=0.015;血红蛋白含量为(123.28±19.29)g/L,高于对照组的(108.37±14.28)g/L,t=7.472,P<0.001。研究组和对照组不良反应发生率分别为10.71%和7.14%,差异无统计学意义,χ~2=0.220,P=0.639。结论 胎盘剥离后大出血患者给予垂体后叶素联合卡前列素氨丁三醇治疗,可取得较好的效果,同时不会增加不良反应。

OBJECTIVE Peeling placenta is an important link in the process of delivery.When peeling placenta in the third stage of labor,it may cause massive bleeding after peeling due to various reasons,such as incomplete peeling,placenta retention or incarceration,placenta implantation,placenta adhesion and so on.This study was to observe the effect of pituitrin and carboprost tromethamine in the treatment of massive hemorrhage after placental dissection.METHODS A total of 56patients with massive hemorrhage after placental dissection were selected from the People′s Hospital of Nanzhao County from February 1,2017to February 28,2019.The study group and the control group were selected according to age,gestational age and mode of delivery,with 28cases in each group.The control group was treated with carboprost tromethamine and the study group was treated with pituitrin.The therapeutic effect,the amount of postpartum hemorrhage,the time of the third stage of labor,the content of hemoglobin and the occurrence of adverse reactions were compared between the two groups.RESULTS The effective rate of postpartum hemorrhage treatment in the control group was 78.57%,significantly lower than 96.43%in the study group,χ2=4.082,P=0.043.The amount of 1hpostpartum hemorrhage of the study group was(255.47±20.43)ml,lower than that of the control group(292.74±30.16)ml,t=11.115,P<0.001.The amount of 3hpostpartum hemorrhage of the study group was(276.57±18.67)ml,lower than that of the control group(307.73±35.08)ml,t=9.895,P<0.001.The amount of 24hpostpartum hemorrhage was(290.51±17.43)ml,lower than(355.75±32.10)ml of the control group,t=10.257,P<0.001.The third stage of labor of the study group was(20.67±1.04)min,shorter than(26.59±1.12)min of the control group,t=5.886,P=0.015.The hemoglobin content was(123.28±19.29)g/L,higher than that of the control group(108.37±14.28)g/L,t=7.472,P<0.001.The incidence of adverse reactions in the study group and the control group were 10.71%and 7.14%,respectively.There was no significant difference,χ2=0.220,P=0.639.CONCLUSION Patients with massive hemorrhage after placental exfoliation can be treated with pituitrin combined with carprostol tromethamine for better results,and combined treatment will not increase adverse reactions.