Objective:To explore the effect of carbetocin in preventing postpartum hemorrhage caused by uterine inertia.Methods: A total of 256 puerpera with single full-term delivery who were admitted in our hospital from May, 2...Objective:To explore the effect of carbetocin in preventing postpartum hemorrhage caused by uterine inertia.Methods: A total of 256 puerpera with single full-term delivery who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into the vaginal delivery group and cesarean section group with 128 cases in each group according to the delivery ways. According to the medication, each group was divided into the carbetocin group and oxytocin group with 64 cases in each group. After fetus delivery, the puerpera in the carbetocin group were given intravenous injection of carbetocin (100μg), while the puerpera in the oxytocin group were given intravenous injection of oxytocin (10 U)+0.9% NaCl (500 mL) for 2 h. The amount of bleeding at delivery, 2 h and 24 h after delivery in each group was observed. A volume of 5 mL elbow venous blood before delivery and 24 h after delivery was extracted. The automatic blood cell analyzer was used to detect the decreased value of 24 h hemoglobin in each group. The coagulation detector was used to detect PT, APTT, and FIB before delivery and 24 h after delivery. The blood pressure and heart rate before and after medication in each group were observed.Results: The amount of bleeding at delivery, 2 h and 24 h after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The decreased value of 24 h hemoglobin after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The indicators of coagulation function 24 h after delivery in each group were not signiifcantly changed (P>0.05). The heart rate and blood pressure after medication in each group were not significantly changed when compared with before medication (P>0.05).Conclusions:Carbetocin can effectively prevent the postpartum hemorrhage caused by uterine inertia, and is safe and effective in application of vaginal delivery and cesarean section;therefore, it deserves to be widely recommended in the clinic.展开更多
Objective::To compare the effects between carbetocin and oxytocin on reducing postpartum hemorrhage(PPH)after vaginal delivery in high risk pregnant women.Methods::A prospective double-blinded randomized study was con...Objective::To compare the effects between carbetocin and oxytocin on reducing postpartum hemorrhage(PPH)after vaginal delivery in high risk pregnant women.Methods::A prospective double-blinded randomized study was conducted in the Nanjing Drum Tower Hospital from March to May 2018.Women at or beyond 28 gestational weeks,cephalic presentation,18-45 years old,and with at least one risk factor for PPH,were enrolled.Using a computer-generated randomization sequence,women were randomized to carbetocin group or oxytocin group which receive 100μg intravenous infusion carbetocin or 10 IU intravenous infusion of oxytocin after anterior shoulder and before placental delivery.The primary outcome was the incidence of blood loss≥500 mL within 24 hours postpartum.The secondary outcomes were amount of total blood loss,blood loss within 2 hours after delivery,the rate of blood loss≥1000 mL postpartum,need for a second-line uterotonics and interventions,blood transfusion,difference between hemoglobin before and 48 hours after delivery,adverse maternal events attributed to the trial medication.Hemodynamic status(blood pressure and pulse)was measured at 0 minutes,30 minutes,60 minutes,and 120 minutes after delivery.Results::A total of 314 and 310 participants constituted the carbetocin and oxytocin groups,respectively.The baseline characteristics were comparable between the groups.The carbetocin group had similar rates of PPH(blood loss≥500 mL)and rates of≥1000 mL PPH,(29.6%vs.26.8%,P=0.48)and(3.2%vs.3.5%,P=0.83),to the oxytocin group.The average amount of bleeding was(422.9±241.4)mL in carbetocin group and(406.0±257.5)mL in oxytocin group,which was no statistically significant difference(P=0.40).Either the amount of blood loss within 2 hours((55.5±33.9)mL vs.(59.9±48.7)mL)was no statistically significant difference(P=0.19).The need for therapeutic uterotonics was 23.9%in carbetocin group and 23.5%in oxytocin group,which was also no statistically difference(P=0.93).The rate of blood transfusion(P=0.62)and hemoglobin change(P=0.07)were not differ between the carbetocin and oxytocin groups.However,the rate of manually removing placenta was significantly different between two groups regarding the need for manually remove of placenta because of uterine bleeding in the third stage of labor(4 cases in carbetocin group vs.13 cases in oxygen group),especially in those after oxytocin-induced or augmented labor(relative risk:3.39,95%confidence interval:1.09-10.52).After delivery,the blood pressure in the carbetocin group tend to be lower than that in the oxytocin group(P>0.05),especially at 30 minutes postpartum(P<0.05),while pulse tend to be simultaneously higher(P>0.05).Conclusion::Among women with high risk of PPH,intravenous carbetocin infusion did not better than oxytocin in the prevention of blood loss≥500 mL after vaginal delivery.展开更多
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...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。展开更多
文摘Objective:To explore the effect of carbetocin in preventing postpartum hemorrhage caused by uterine inertia.Methods: A total of 256 puerpera with single full-term delivery who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into the vaginal delivery group and cesarean section group with 128 cases in each group according to the delivery ways. According to the medication, each group was divided into the carbetocin group and oxytocin group with 64 cases in each group. After fetus delivery, the puerpera in the carbetocin group were given intravenous injection of carbetocin (100μg), while the puerpera in the oxytocin group were given intravenous injection of oxytocin (10 U)+0.9% NaCl (500 mL) for 2 h. The amount of bleeding at delivery, 2 h and 24 h after delivery in each group was observed. A volume of 5 mL elbow venous blood before delivery and 24 h after delivery was extracted. The automatic blood cell analyzer was used to detect the decreased value of 24 h hemoglobin in each group. The coagulation detector was used to detect PT, APTT, and FIB before delivery and 24 h after delivery. The blood pressure and heart rate before and after medication in each group were observed.Results: The amount of bleeding at delivery, 2 h and 24 h after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The decreased value of 24 h hemoglobin after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The indicators of coagulation function 24 h after delivery in each group were not signiifcantly changed (P>0.05). The heart rate and blood pressure after medication in each group were not significantly changed when compared with before medication (P>0.05).Conclusions:Carbetocin can effectively prevent the postpartum hemorrhage caused by uterine inertia, and is safe and effective in application of vaginal delivery and cesarean section;therefore, it deserves to be widely recommended in the clinic.
文摘Objective::To compare the effects between carbetocin and oxytocin on reducing postpartum hemorrhage(PPH)after vaginal delivery in high risk pregnant women.Methods::A prospective double-blinded randomized study was conducted in the Nanjing Drum Tower Hospital from March to May 2018.Women at or beyond 28 gestational weeks,cephalic presentation,18-45 years old,and with at least one risk factor for PPH,were enrolled.Using a computer-generated randomization sequence,women were randomized to carbetocin group or oxytocin group which receive 100μg intravenous infusion carbetocin or 10 IU intravenous infusion of oxytocin after anterior shoulder and before placental delivery.The primary outcome was the incidence of blood loss≥500 mL within 24 hours postpartum.The secondary outcomes were amount of total blood loss,blood loss within 2 hours after delivery,the rate of blood loss≥1000 mL postpartum,need for a second-line uterotonics and interventions,blood transfusion,difference between hemoglobin before and 48 hours after delivery,adverse maternal events attributed to the trial medication.Hemodynamic status(blood pressure and pulse)was measured at 0 minutes,30 minutes,60 minutes,and 120 minutes after delivery.Results::A total of 314 and 310 participants constituted the carbetocin and oxytocin groups,respectively.The baseline characteristics were comparable between the groups.The carbetocin group had similar rates of PPH(blood loss≥500 mL)and rates of≥1000 mL PPH,(29.6%vs.26.8%,P=0.48)and(3.2%vs.3.5%,P=0.83),to the oxytocin group.The average amount of bleeding was(422.9±241.4)mL in carbetocin group and(406.0±257.5)mL in oxytocin group,which was no statistically significant difference(P=0.40).Either the amount of blood loss within 2 hours((55.5±33.9)mL vs.(59.9±48.7)mL)was no statistically significant difference(P=0.19).The need for therapeutic uterotonics was 23.9%in carbetocin group and 23.5%in oxytocin group,which was also no statistically difference(P=0.93).The rate of blood transfusion(P=0.62)and hemoglobin change(P=0.07)were not differ between the carbetocin and oxytocin groups.However,the rate of manually removing placenta was significantly different between two groups regarding the need for manually remove of placenta because of uterine bleeding in the third stage of labor(4 cases in carbetocin group vs.13 cases in oxygen group),especially in those after oxytocin-induced or augmented labor(relative risk:3.39,95%confidence interval:1.09-10.52).After delivery,the blood pressure in the carbetocin group tend to be lower than that in the oxytocin group(P>0.05),especially at 30 minutes postpartum(P<0.05),while pulse tend to be simultaneously higher(P>0.05).Conclusion::Among women with high risk of PPH,intravenous carbetocin infusion did not better than oxytocin in the prevention of blood loss≥500 mL after vaginal delivery.
文摘目的 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。
