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产后出血是分娩期严重并发症,是导致产妇死亡的最主要原因。临床上产后出血是指胎儿娩出后24 h内出血量达到500 mL,剖宫产产时失血量超过1 000 mL[1]。相较于自然分娩,剖宫产产后发生出血概率更高。70%以上剖宫产产后出血是由宫缩乏力导致的[2]。及时有效地对产妇宫缩乏力进行处理能够有效地预防产后出血,是产妇生命安全和生育能力保留的重要保障。产妇羊水过多、妊娠期高血压、前置胎盘、多胎妊娠等危险因素均能显著提高产后出血发生率[3]。卡前列素氨丁三醇和卡前列甲酯栓是治疗和预防宫缩乏力性产后出血的有效方法,但对于高危妊娠产妇其效果尚无统一定论。本次研究探讨在高危妊娠行剖宫产产妇中预防性使用卡前列素氨丁三醇和卡前列甲酯栓的效果。现作报道。
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术中、术后2 h和术后24 h,A组产妇出血量均显著少于B组(P < 0.05~P < 0.01)(见表 1)。
分组 n 术中 术后2 h 术后24 h A组 90 342.5±125.7 101.7±48.5 63.9±28.7 B组 90 387.7±134.6 138.5±53.4 81.6±30.5 t — 2.33 4.84 4.01 P — < 0.05 < 0.01 < 0.01 表 1 2组术中、术后2 h、术后24 h出血量比较(x±s;mL)
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2组产妇产后出血发生率、输血率和附加止血措施干预率差异均无统计学意义(P>0.05)(见表 2);A组12例产后出血产妇平均出血量为(841.34±232.56)mL,B组17例产后出血产妇平均出血量为(857.62±227.37)mL, 2组间差异无统计学意义(t=0.19,P>0.05)。
分组 n 产后出血率 输血率 附加止血措施干预率 A组 90 12(13.33) 8(8.89) 10(11.11) B组 90 17(18.89) 11(12.22) 14(15.56) χ2 — 1.03 0.53 0.77 P — >0.05 >0.05 >0.05 表 2 2组产后出血发生率、输血率和附加止血措施干预率比较[n;百分率(%)]
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A组恶心呕吐4例, 发热2例, 腹泻2例, 血压升高3例,不良反应发生率为12.22%,B组恶心呕吐5例, 发热3例, 腹泻1例, 血压升高4例,不良反应发生率为14.44%,2组不良反应发生率差异无统计学意义(χ2=0.19,P>0.05)。其中A组1例产妇发生严重腹泻,经对症治疗后好转,其余产妇不良反应均未进行特殊治疗,在短时间内好转。
前列腺素类药物联合缩宫素预防高危妊娠剖宫产产后出血效果观察
Clinical effect of prostaglandins combined with oxytocin in the prevention of high risk pregnancy and postpartum hemorrhage after cesarean section
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摘要:
目的探讨卡前列素氨丁三醇或卡前列甲酯栓联合缩宫素对高危妊娠行剖宫产产妇产后出血的预防效果。 方法选择180例高危妊娠行剖宫产产妇作为研究对象,按照随机数表法分为A组和B组,每组各90例。A组在娩后给予10 U缩宫素静脉滴注和250 μg卡前列素氨丁三醇宫体肌内注射,B组给予10 U缩宫素静脉滴注和1 mg卡前列甲酯栓舌下含化。对2组产后各时间段出血量、产后出血率、输血率、附加止血措施干预率和不良反应发生情况进行观察和比较。 结果术中、术后2 h和术后24 h,A组产妇出血量均显著少于B组(P < 0.05~P < 0.01)。2组产妇产后出血发生率、输血率和附加止血措施干预率差异均无统计学意义(P>0.05);A组12例产后出血产妇平均出血量为(841.34±232.56)mL,B组17例产后出血产妇平均出血量为(857.62±227.37)mL,2组间差异无统计学意义(P>0.05)。2组不良反应发生率差异无统计学意义(P>0.05)。 结论卡前列素氨丁三醇和卡前列甲酯栓联合缩宫素对高危妊娠行剖宫产产妇产后出血均有较好的预防效果,不良反应较小。其中使用卡前列素氨丁三醇在减少出血量上具有一定的优势。 Abstract:ObjectiveTo investigate the preventive effects of carboprost tromethamine or carboprost methylate combined with oxytocin on postpartum hemorrhage in high risk pregnant women treated with cesarean section. MethodsOne hundred and eighty high risk pregnant women treated with cesarean section were randomly divided into group A and group B(90 cases each group).Group A was intravenously injected with 10 U oxytocin combined with intramuscular injection 250 μg carboprost tromethamine, and group B was intravenously injected with 10 U oxytocin combined with 1 mg carboprost methylate by sublingual administration after delivery.The amount of bleeding, and rates of postpartum hemorrhage, blood transfusion, intervention of additional hemostasis and occurrence of adverse reaction were compared between two groups. ResultsThe intraoperative, postoperative 2 h and postoperative 24 h haemorrhage amount in group A were significantly less than those in group B(P < 0.05 to P < 0.01).The differences of the incidence of postpartum hemorrhage, and rates of blood transfusion and intervention of additional hemostatic measures between two groups were not statistically significnat(P>0.05).The average amount of postpartum bleeding in 12 cases of group A and 17 cases of group B were[(841.34±232.56)mL] and[(857.62±227.37)mL], respectively, and the difference of which was not statistically significant(P>0.05).The difference of the incidence rate of adverse reaction between two gorups was not statistically significant(P>0.05). ConclusionsCarboprost tromethamine or carboprost methylate combined with oxytocin in treating postpartum hemorrhage in high-risk pregnant treated with cesarean section has good preventive effect and less side effects.Carboprost tromethamine has a certain advantage in reducing the amount of bleeding. -
Key words:
- postpartum hemorrhage /
- carboprost tromethamine /
- carboprost methylate /
- oxytocin /
- high risk pregnancy
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表 1 2组术中、术后2 h、术后24 h出血量比较(x±s;mL)
分组 n 术中 术后2 h 术后24 h A组 90 342.5±125.7 101.7±48.5 63.9±28.7 B组 90 387.7±134.6 138.5±53.4 81.6±30.5 t — 2.33 4.84 4.01 P — < 0.05 < 0.01 < 0.01 表 2 2组产后出血发生率、输血率和附加止血措施干预率比较[n;百分率(%)]
分组 n 产后出血率 输血率 附加止血措施干预率 A组 90 12(13.33) 8(8.89) 10(11.11) B组 90 17(18.89) 11(12.22) 14(15.56) χ2 — 1.03 0.53 0.77 P — >0.05 >0.05 >0.05 -
[1] 庞土寿.缩宫素联合前列腺素类药物预防高危妊娠且行剖宫产产后出血的临床观察[J].临床医学工程, 2016, 23(11):1497. doi: 10.3969/j.issn.1674-4659.2016.11.1497 [2] 刘亚新.卡前列甲酯栓联合催产素预防高危妊娠剖宫产宫缩乏力性出血临床观察[J].中国处方药, 2017, 15(07):89. doi: 10.3969/j.issn.1671-945X.2017.07.061 [3] 刘伟靓, 姚丽, 曹士红, 等.产褥期感染相关危险因素的评估[J].郑州大学学报(医学版), 2017, 52(2):205. [4] 戴中超.卡前列素氨丁三醇预防高危妊娠产妇产后出血的临床疗效[J].临床合理用药杂志, 2016, 9(6):15. [5] 王瑞姣, 韩汝芳, 颜杰文, 等.缩宫素联合卡前列素氨丁三醇预防高危产妇剖宫产产后出血的效果研究[J].中国妇幼保健, 2016, 31(15):3033. [6] 连海丽.卡前列素氨丁三醇联合缩宫素在高危妊娠剖宫产术后产后出血的防治效果[J].中国实用医药, 2016, 11(29):175. [7] 谢幸, 苟文丽.妇产科学[M].8版.北京:人民卫生出版社, 2013. [8] 潘琴.卡前列素氨丁三醇联合缩宫素在高危妊娠且行剖宫产术中的应用价值分析[J].解放军医药杂志, 2017, 29(9):6. doi: 10.3969/j.issn.2095-140X.2017.09.002 [9] 李丽, 袁秀红, 罗晓梅, 等.缩宫素联合前列腺素类药物预防高危妊娠且行剖宫产产后出血的临床观察[J].现代药物与临床, 2014, 29(6):619. [10] 刘晓霞.卡前列甲酯栓联合卡前列素氨丁三醇治疗宫缩乏力性产后出血的临床研究[J].中国基层医药, 2017, 24(2):231. doi: 10.3760/cma.j.issn.1008-6706.2017.02.019 [11] 涂红星.高危妊娠行剖宫产产后出血的预防[J].中国妇幼保健, 2013, 28(21):3428. doi: 10.7620/zgfybj.j.issn.1001-4411.2013.21.15 [12] 王琼林, 王梅, 王睿.卡前列素氨丁三醇预防性用于产后出血高危因素产妇疗效观察[J].现代中西医结合杂志, 2013, 22(23):2538. doi: 10.3969/j.issn.1008-8849.2013.23.011 [13] 赵荷兰.米索前列醇联合缩宫素在防止高危产妇剖宫产术中术后出血的效果研究[J].实用预防医学, 2015, 22(1):82. doi: 10.3969/j.issn.1006-3110.2015.01.025 [14] 王少梅.卡前列素氨丁三醇预防高危妊娠剖宫产产后出血的临床疗效及安全性探讨[J].中国当代医药, 2014, 21(7):81. [15] 牛丽娜, 李晓琴, 马萍.卡前列素氨丁三醇注射液联合低位B-Lynch缝合术治疗难治性前置胎盘产后出血的临床疗效及安全性评价[J].中国基层医药, 2016, 23(20):3087. doi: 10.3760/cma.j.issn.1008-6706.2016.20.013 [16] 冯可几, 王馨芸.高危妊娠剖宫产孕妇应用益母草联合卡前列甲酯栓的效果观察[J].临床合理用药杂志, 2012, 5(21):60. doi: 10.3969/j.issn.1674-3296.2012.21.046