張秋紅 張繼紅
摘 要 目的:探討縮宮素聯(lián)合卡前列素氨丁三醇子宮肌層注射治療宮縮乏力性產(chǎn)后出血的臨床價(jià)值。方法:選擇2018年4月至2020年4月收治的宮縮乏力性產(chǎn)后出血患者96例,按照隨機(jī)數(shù)字表對(duì)照法分為兩組各48例。兩組均采用雙側(cè)子宮動(dòng)脈上行支結(jié)扎止血,在胎兒娩出之后,對(duì)照組在子宮肌壁注射縮宮素10 U,然后靜脈滴注含有縮宮素10 U的5%葡萄糖溶液500 ml;觀察組在對(duì)照組基礎(chǔ)上再在子宮肌層注射卡前列素氨丁三醇250 μg/次,單日最大劑量為1 500 μg。觀察兩組療效、臨床指標(biāo)、血氧飽和度、舒張壓、收縮壓、宮底下降速度和惡露持續(xù)時(shí)間。結(jié)果:觀察組總有效率為95.83%(46/48),高于對(duì)照組的79.17%(38/48,P<0.05)。觀察組的出血量和輸血量分別為(512.18±54.28)ml和(519.66±52.28)ml,少于對(duì)照組的(614.89±62.18)ml和(569.67±56.64)ml(P<0.05)。觀察組的止血起效時(shí)間和宮縮持續(xù)時(shí)間和住院時(shí)間亦短于對(duì)照組(P<0.05)。觀察組和對(duì)照組在血氧飽和度、舒張壓、收縮壓方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。觀察組宮底下降速度較快,惡露持續(xù)時(shí)間較短(P<0.05)。結(jié)論:對(duì)于產(chǎn)后宮縮乏力性出血的產(chǎn)婦,通過(guò)卡前列素氨丁三醇子宮肌層注射治療,可以改善療效,減少出血量和輸血量,加快止血進(jìn)度,還能改善宮底高度,減少惡露持續(xù)時(shí)間,不影響產(chǎn)婦的相關(guān)生理指標(biāo),應(yīng)用價(jià)值較高。
關(guān)鍵詞 產(chǎn)后宮縮乏力性產(chǎn)后出血;卡前列素氨丁三醇;子宮肌層
中圖分類(lèi)號(hào):R714.46+1 文獻(xiàn)標(biāo)志碼:A 文章編號(hào):1006-1533(2021)10-0029-03
Clinical study of oxytocin combined with carboprost tromethamine injection in the treatment of postpartum hemorrhage due to uterine inertia
ZHANG Qiuhong, ZHANG Jihong
(Second Department of Obstetrics of Maternal and Child Health Care Hospital of Xinyu, Jiangxi 338000, China)
ABSTRACT Objective: To explore the clinical value of oxytocin combined with carprost tromethamine injection in the treatment of postpartum hemorrhage due to uterine inertia. Methods: From April 2018 to April 2020, 96 patients with postpartum hemorrhage due to uterine inertia were selected, and according to the random number table comparison method divided into two groups with 48 cases in each group. Both groups were ligated bilateral ascending branches of uterine artery to stop bleeding. After the fetus was delivered, the control group was injected with 10 U of oxytocin into the uterine muscle wall, and then intravenously infused with 500 ml of a 5% glucose solution containing 10 U of oxytocin; in the observation group, on the basis of the control group, carboprost tromethamine was injected 250 μg/time into the myometrium, and the maximum single-day dose was 1 500 μg. The curative effect, clinical indexes, blood oxygen saturation, diastolic blood pressure, systolic blood pressure, descending speed of uterine fundus and duration of lochia were observed. Results: The total effective rate in the observation group was 95.83%(46/48), which was higher than that in the control group 79.17%(38/48, P<0.05). The amounts of bleeding and blood transfusion in the observation group were (512.18±54.28) ml and (519.66±52.28) ml, respectively, which were less than those in the control group (614.89±62.18) ml and (569.67±56.64) ml(P<0.05). The onset time of hemostasis, duration of uterine contraction and hospitalization time in the observation group were also shorter than those in the control group(P<0.05). There was no significant difference in oxygen saturation, diastolic blood pressure and systolic blood pressure between the two groups(P>0.05). In the observation group, the descending speed of fundus uteri was faster and the duration of lochia was shorter(P<0.05). Conclusion: For the parturients with postpartum hemorrhage due to uterine inertia, carboprost tromethamine injection can improve the curative effect, reduce the amount of bleeding and blood transfusion, and speed up the progress of hemostasis, reduce the duration of lochia, and can not affect the relevant physiological indicators of the parturient, which has high application value.
KEY WORDS postpartum hemorrhage due to uterine inertia; carboprost tromethamine; myometrium
產(chǎn)后出血是產(chǎn)科常見(jiàn)并發(fā)癥,產(chǎn)婦在胎兒娩出后24 h的剖宮產(chǎn)出血量超過(guò)1 000 ml,造成這一癥狀的主要原因是宮縮乏力,需要積極進(jìn)行干預(yù),避免發(fā)生多臟器功能缺血,進(jìn)而影響機(jī)體的正常功能,甚至危及生命[1]。已有研究認(rèn)為,卡前列素氨丁三醇治療產(chǎn)后出血的效果明顯[2-3]。本文報(bào)道用卡前列素氨丁三醇治療產(chǎn)后宮縮乏力性產(chǎn)后出血的療效。
1 資料與方法
1.1 一般資料
選擇2018年4月-2020年4月收治的產(chǎn)后出血患者96例,均為單胎,在胎兒娩出后24 h內(nèi),剖宮產(chǎn)出血量達(dá)1 000 ml及以上。將患者按照隨機(jī)數(shù)字表對(duì)照法分為兩組各48例。觀察組患者年齡為23~35歲,平均(27.14±7.25)歲;孕周37~41周,平均(38.67±1.03)周;初產(chǎn)婦28例,經(jīng)產(chǎn)婦20例;產(chǎn)次1~3次,平均(1.56±0.23)次。對(duì)照組患者年齡為23~34歲,平均(28.16±7.11)歲;孕周37~41周,平均(38.96±1.04)周;初產(chǎn)婦29例,經(jīng)產(chǎn)婦19例;產(chǎn)次1~3次,平均(1.77±0.25)次。兩組患者的上述基線資料差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)?;颊呒覍倬橥獠⒑炇鹣嚓P(guān)文件。排除產(chǎn)婦合并凝血功能障礙及重要臟器疾病情況。
1.2 方法
兩組均于腰硬聯(lián)合麻醉后行雙側(cè)子宮動(dòng)脈上行支結(jié)扎止血。對(duì)照組在胎兒娩出后,在子宮肌壁注射縮宮素(馬鞍山豐原藥業(yè)制藥有限公司)10 U,然后靜脈滴注含10 U縮宮素的5%葡萄糖溶液500 ml。觀察組在對(duì)照組的基礎(chǔ)上,于子宮肌層注射卡前列素氨丁三醇(美國(guó)Pharmacia and Upjohn Company )250 μg/次,單日最大劑量為1 500 μg。觀察兩組療效、臨床指標(biāo)、血氧飽和度、舒張壓、收縮壓、宮底下降速度、惡露持續(xù)時(shí)間。
1.3 療效評(píng)價(jià)[4]
顯效為產(chǎn)婦陰道出血量低于30 ml/h,而且子宮收縮良好,相關(guān)生理指標(biāo)穩(wěn)定;有效為產(chǎn)婦陰道出血量30~50 ml/h,而且子宮收縮良好,相關(guān)生理指標(biāo)穩(wěn)定;無(wú)效為產(chǎn)婦陰道出血量>50 ml/h,而且子宮收縮欠佳,相關(guān)生理指標(biāo)惡化??傆行?(顯效例數(shù)+有效例數(shù))/總例數(shù)×100%。
1.4 統(tǒng)計(jì)學(xué)分析
2 結(jié)果
2.1 兩組療效對(duì)比
觀察組總有效率為95.83%,高于對(duì)照組的79.17%,組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。見(jiàn)表1。
2.2 兩組臨床指標(biāo)對(duì)比
觀察組的出血量、輸血量少于對(duì)照組(P<0.05);止血起效時(shí)間、宮縮持續(xù)時(shí)間短于對(duì)照組(P<0.05);住院時(shí)間少于對(duì)照組(P<0.05)。見(jiàn)表2。
2.3 兩組血氧飽和度、舒張壓、收縮壓對(duì)比
觀察組和對(duì)照組在血氧飽和度、舒張壓、收縮壓方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),見(jiàn)表3。
2.4 兩組宮底下降速度、惡露持續(xù)時(shí)間對(duì)比
觀察組宮底下降速度較快,惡露持續(xù)時(shí)間較短,組間差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表4。
3 討論
產(chǎn)后出血是產(chǎn)科嚴(yán)重并發(fā)癥之一,其發(fā)病因素和胎盤(pán)因素、軟產(chǎn)道損傷、宮縮乏力等有密切聯(lián)系,產(chǎn)婦發(fā)生產(chǎn)后出血后,會(huì)增加感染、休克等情況的發(fā)生,嚴(yán)重者造成死亡[5-7]?,F(xiàn)階段,主要是通過(guò)保守治療、手術(shù)治療等方式改善出血狀況,避免發(fā)生惡性后果[8]。一般認(rèn)為,保守治療效果欠佳[9]。因此,通過(guò)雙側(cè)子宮動(dòng)脈上行支結(jié)扎的方法比較常用,且創(chuàng)傷小,止血速度快。
本文結(jié)果顯示,觀察組總有效率為95.83%,高于對(duì)照組的79.17%(P<0.05),說(shuō)明治療效果較好。觀察組的出血量、輸血量少于對(duì)照組(P<0.05),止血起效時(shí)間、宮縮持續(xù)時(shí)間短于對(duì)照組(P<0.05),住院時(shí)間少于對(duì)照組(P<0.05),說(shuō)明止血效果明顯,可以快速止血,改善宮縮狀況,縮短產(chǎn)婦的住院時(shí)間。觀察組和對(duì)照組在血氧飽和度、舒張壓、收縮壓方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。觀察組宮底下降速度較快,惡露持續(xù)時(shí)間較短(P<0.05),說(shuō)明不僅干預(yù)效果好,還不影響機(jī)體的生理指標(biāo)?,F(xiàn)階段,在止血的同時(shí),可以采取縮宮素輔助治療,當(dāng)然,縮宮素的使用與受體飽和度有一定的關(guān)系,容易發(fā)生低血壓、水中毒等情況,作用時(shí)間短,效果并不理想[10],而且其作用靶點(diǎn)易飽和,半衰期較短,藥效持續(xù)時(shí)間短,預(yù)后較差??ㄇ傲兴匕倍∪际菫榍傲邢偎谽1衍生物,能夠促進(jìn)機(jī)體對(duì)鈣離子的吸收,從而提高子宮平滑肌的收縮功能[11-12]。而且,該藥物還有著較好的收縮血管的價(jià)值,能夠使子宮血竇閉合能力提高,改善內(nèi)膜供血狀況,可以促進(jìn)子宮調(diào)理效果,而且作用效果較好,劑量使用相對(duì)較低,止血效果值得肯定[13-14]。通過(guò)聯(lián)合用應(yīng)藥宮縮素和卡前列素氨丁三醇,明顯改善預(yù)后,提高了治療效果。
總之,對(duì)于產(chǎn)后宮縮乏力性產(chǎn)后出血的產(chǎn)婦,通過(guò)卡前列素氨丁三醇子宮肌層注射治療,可以改善療效,減少出血量和輸血量,加快止血進(jìn)度,早日出院,還能夠改善宮底高度,減少惡露持續(xù)時(shí)間,不影響產(chǎn)婦的相關(guān)生理指標(biāo),應(yīng)用價(jià)值較高。
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