蛇毒血凝酶联合缩宫素治疗高龄产妇剖宫产术后出血的临床研究
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摘要
目的探讨蛇毒血凝酶联合缩宫素治疗高龄产妇剖宫产术后出血的临床疗效。方法选取2016年1月—2018年4月宜昌市第二人民医院收治的剖宫产术后出血的高龄产妇376例,随机分为对照组和治疗组,每组各188例。对照组在胎儿娩出后立即向切口上方的子宫肌壁注射缩宫素注射液20 U,然后将20 U缩宫素注射液加入0.9%氯化钠注射液250 mL中,静脉滴注,以后每天静脉滴注缩宫素20U。治疗组在对照组的基础上在胎儿娩出后立即向切口上方的子宫肌壁注射蛇毒血凝酶注射液1 U,以后每天肌肉注射蛇毒血凝酶注射液1 U,两组均连续治疗3 d。观察两组患者的临床疗效,同时比较两组患者的产后出血率、出血量、第三产程时间、恶露持续时间、住院时间、子宫底高度、D-二聚体、血红蛋白(Hb)、血浆纤维蛋白原(FIB)水平发生情况。结果治疗后,对照组和治疗组的总有效率分别是77.13%、89.36%,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组产后出血率、出血量、第三产程时间、恶露持续时间、住院时间、子宫底高度均显著小于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组D-二聚体、Hb、FIB水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗后治疗组D-二聚体、Hb、FIB水平明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论蛇毒血凝酶联合缩宫素治疗剖宫产术后出血具有较好的临床疗效,可显著降低术中及术后出血量和出血率,缩短第三产程时间、恶露持续时间,促进子宫复旧。
Objective To observe the clinical effect of hemocoagulase combined with oxytocin in treatment of postpartum hemorrhage after cesarean section in older maternal. Methods Patients(376 cases) with postpartum hemorrhage after cesarean section in Second People's Hospital of Yichang City from January 2016 to April 2018 were randomly divided into control and treatment groups, and each group had 188 cases. Patients in the control group were iv administered with Oxytocin Injection 20 U in uterine muscle wall above the incision after the foetus parturition, and iv drip with Oxytocin Injection, 20 U added into 0.9% Sodium Chloride Injection 250 mL, every day. Patients in the treatment group were iv administered with Hemocoagulase Injection 1 U in uterine muscle wall above the incision after the foetus parturition, and then im administered with Hemocoagulase Injection 1 U every day. Patients in two groups were treated for 3 d. After treatment, the clinical efficacy was evaluated, and postpartum hemorrhage rate, bleeding volume, third process time, lochia duration, hospital stay, postpartum uterine fundus height, D-dimer, hemoglobin(Hb), and fibrinogen(FIB) in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 77.13% and 89.36%, and there were differences between two groups(P < 0.05). After treatment, postpartum hemorrhage rate, bleeding volume, third process time, lochia duration, hospital stay, and postpartum uterine fundus height in the treatment group were significantly lower than those in the control group, and there were differences between two groups(P < 0.05). After treatment, D-dimer, Hb, and FIB in two groups were significantly decreased, and there were differences in the same group(P < 0.05). After treatment, D-dimer, Hb, and FIB levels in the treatment group were significantly lower than those in the control group, and there were differences between two groups(P < 0.05). Conclusion Hemocoagulase combined with oxytocin has clinical curative effect in treatment of postpartum hemorrhage after cesarean section, can significantly reduce bleeding volume and postpartum hemorrhage rate, shorten third process time and lochia duration, and accelerate the recovery of uterus.
Objective To observe the clinical effect of hemocoagulase combined with oxytocin in treatment of postpartum hemorrhage after cesarean section in older maternal. Methods Patients(376 cases) with postpartum hemorrhage after cesarean section in Second People's Hospital of Yichang City from January 2016 to April 2018 were randomly divided into control and treatment groups, and each group had 188 cases. Patients in the control group were iv administered with Oxytocin Injection 20 U in uterine muscle wall above the incision after the foetus parturition, and iv drip with Oxytocin Injection, 20 U added into 0.9% Sodium Chloride Injection 250 mL, every day. Patients in the treatment group were iv administered with Hemocoagulase Injection 1 U in uterine muscle wall above the incision after the foetus parturition, and then im administered with Hemocoagulase Injection 1 U every day. Patients in two groups were treated for 3 d. After treatment, the clinical efficacy was evaluated, and postpartum hemorrhage rate, bleeding volume, third process time, lochia duration, hospital stay, postpartum uterine fundus height, D-dimer, hemoglobin(Hb), and fibrinogen(FIB) in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 77.13% and 89.36%, and there were differences between two groups(P < 0.05). After treatment, postpartum hemorrhage rate, bleeding volume, third process time, lochia duration, hospital stay, and postpartum uterine fundus height in the treatment group were significantly lower than those in the control group, and there were differences between two groups(P < 0.05). After treatment, D-dimer, Hb, and FIB in two groups were significantly decreased, and there were differences in the same group(P < 0.05). After treatment, D-dimer, Hb, and FIB levels in the treatment group were significantly lower than those in the control group, and there were differences between two groups(P < 0.05). Conclusion Hemocoagulase combined with oxytocin has clinical curative effect in treatment of postpartum hemorrhage after cesarean section, can significantly reduce bleeding volume and postpartum hemorrhage rate, shorten third process time and lochia duration, and accelerate the recovery of uterus.
引文
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[8]刘兴会,张力,张静.《产后出血预防与处理指南(草案)》(2009)及《产后出血预防与处理指南(2014年版)》解读[J].中华妇幼临床医学杂志:电子版,2015,11(4):433-447.
[9]中华医学会妇产科学分会产科学组.产后出血预防与处理指南(2014)[J].中华妇产科杂志,2014,49(9):641-646
[10]倪飞英.剖宫产产后出血186例临床分析[J].海南医学,2009,20(5):55-57.
[11]付景丽,郑剑兰,张小琼,等.剖宫产产后出血的临床分析[J].现代妇产科进展,2012,24(3):215-217.
[12]王新彦,李洪霞,冀涛,等.剖宫产产后出血的相关因素病例对照研究[J].中国妇幼保健,2013,28(6):1052-1056.
[13]Balki M,Ronayne M,Davies S,et al.Minimum oxytocin dose requirement after cesarean delivery for labor arrest[J].Obstetr Gynecol,2006,107(1):45-50.
[14]Tang S S,Zhang J H,Tang B S,et al.Biochemical and hemostatic mechanism of a novel thrombin like enzyme[J].Thromb Res,2008,104(5):631-639.
[15]张军,柳苍生,王生华,等.蛇毒血凝酶对肺结核患者术中出渗血量与凝血功能的影响[J].山东医药,2010,50(40):21-23.
[16]陈步云,胡品佳,黄焕馨.第三产程时间与产后出血的关系[J].国际医药卫生导报,2012,18(1):113-115.
[17]徐晓艳.正常产褥期妇女恶露时间及影响因素的研究[D].太原:山西医科大学,2014.
[18]张婧,陈莉,李小英.孕妇剖宫产前后凝血四项预测产后出血的检验分析[J].中国性科学,2018,25(2):85-88.
[2]严宇,孙江川,常淑芳.宫缩乏力性产后出血治疗现状[J].中国实用妇科与产科杂志,2010,26(2):149-151.
[3]付晨薇,刘俊涛.如何规范产后出血的药物治疗[J].中国实用妇科与产科杂志,2014,30(4):262-265.
[4]陈孝平,吴在德.蛇毒血凝酶研究进展和在临床应用安全性评价[J].重庆医学,2011,49(3):27-29.
[5]杨亚琼,陈宁,郭建,等.蛇毒类血凝酶用于外科手术切口有效性和安全性的系统评价[J].中国循证医学杂志,2015,15(11):1309-1316.
[6]訾聃,李智,渠秀茹.蛇毒血凝酶纱条宫腔填塞术治疗剖宫产术中大出血及治疗妊娠期特发性血小板减少性紫癜剖宫产产后出血的探讨[J].中国妇幼保健,2009,24(3):316-317.
[7]张志伟,韩瑞花.蛇毒血凝酶在剖宫产术中的应用[J].实用医技杂志,2006,13(6):953-954.
[8]刘兴会,张力,张静.《产后出血预防与处理指南(草案)》(2009)及《产后出血预防与处理指南(2014年版)》解读[J].中华妇幼临床医学杂志:电子版,2015,11(4):433-447.
[9]中华医学会妇产科学分会产科学组.产后出血预防与处理指南(2014)[J].中华妇产科杂志,2014,49(9):641-646
[10]倪飞英.剖宫产产后出血186例临床分析[J].海南医学,2009,20(5):55-57.
[11]付景丽,郑剑兰,张小琼,等.剖宫产产后出血的临床分析[J].现代妇产科进展,2012,24(3):215-217.
[12]王新彦,李洪霞,冀涛,等.剖宫产产后出血的相关因素病例对照研究[J].中国妇幼保健,2013,28(6):1052-1056.
[13]Balki M,Ronayne M,Davies S,et al.Minimum oxytocin dose requirement after cesarean delivery for labor arrest[J].Obstetr Gynecol,2006,107(1):45-50.
[14]Tang S S,Zhang J H,Tang B S,et al.Biochemical and hemostatic mechanism of a novel thrombin like enzyme[J].Thromb Res,2008,104(5):631-639.
[15]张军,柳苍生,王生华,等.蛇毒血凝酶对肺结核患者术中出渗血量与凝血功能的影响[J].山东医药,2010,50(40):21-23.
[16]陈步云,胡品佳,黄焕馨.第三产程时间与产后出血的关系[J].国际医药卫生导报,2012,18(1):113-115.
[17]徐晓艳.正常产褥期妇女恶露时间及影响因素的研究[D].太原:山西医科大学,2014.
[18]张婧,陈莉,李小英.孕妇剖宫产前后凝血四项预测产后出血的检验分析[J].中国性科学,2018,25(2):85-88.