卡前列素氨丁三醇注射液联合米索前列醇片治疗妊娠宫缩乏力性产后出血的临床研究
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摘要
目的观察卡前列素氨丁三醇注射液联合米索前列醇片用于妊娠宫缩乏力性产后出血的临床疗效及安全性。方法将146例妊娠宫缩乏力性产后出血患者随机分为对照组和试验组,每组73例。待胎儿娩出后,对照组予以米索前列醇200μg,直肠给药;试验组在对照组治疗的基础上,予以卡前列素氨丁三醇250μg,子宫肌层注射(必要时重复给药,但总量<2000μg)。比较2组患者的临床疗效、出血情况、脑钠肽(BNP)水平,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为95. 89%(70例/73例)和86. 31%(63例/73例),差异有统计学意义(P <0. 05)。治疗后,试验组和对照组的产后2 h出血量分别为(219. 75±30. 27)和(358. 96±49. 84) m L,产后24 h出血量分别为(271. 18±32. 85)和(463. 25±60. 07) m L,止血时间分别为(18. 63±2. 59)和(31. 82±3. 96) min,BNP分别为(42. 58±5. 32)和(86. 64±10. 15) pg·m L~(-1),差异均有统计学意义(均P <0. 05)。2组患者出现的药物不良反应主要有消化道反应、心率加快、头痛及面色潮红,试验组和对照组的总药物不良反应发生率分别为9. 08%和20. 55%,差异有统计学意义(P <0. 05)。结论卡前列素氨丁三醇注射液联合米索前列醇片能明显降低妊娠宫缩乏力性产后出血患者的出血量,缩短出血时间,且安全性较高。
Objective To observe the clinical efficacy and safety of carboprost tromethamine injection combined with misoprostol tablets in the treatment of pregnancy postpartum hemorrhage due to uterine atony.Methods A total of 146 patients with pregnancy postpartum hemorrhage due to uterine atony were randomly divided into control and treatment groups with 73 cases per group. Control group was treated with misoprostol 200 μg by rectal administration. Treatment group was treated with carboprost tromethamine 250 μg by the myometrium injection( repeated administration if necessary,but the total amount < 2000 μg),on the basis of control group. The clinical efficacy,bleeding condition,levels of brain natriuretic peptide( BNP) and adverse drug reactions were compared between two groups. Results After treatment,the total effective rates of treatment and control groups were 95. 89%( 70 cases/73 cases)and 86. 31 %( 63 cases/73 cases) with significant difference( P < 0. 05). After treatment,the main indexes of treatment and control groups were compared: volume of postpartum hemorrhage in 2 h were( 219. 75 ± 30. 27) and( 358. 96 ± 49. 84) m L,volume of postpartum hemorrhage in 24 h were( 271. 18 ± 32. 85) and( 463. 25 ± 60. 07) m L,hemostasis time were( 18. 63 ± 2. 59) and( 31. 82 ± 3. 96) min,BNP were( 42. 58 ± 5. 32) and( 86. 64 ± 10. 15) pg·m L~(-1),the differences were statistically significant( all P < 0. 05).The adverse drug reactions of two groups were alimentary tract reaction,heart rate increase,headache and flush. The total incidences of adverse drug reactions in treatment and control groups were 9. 08% and 20. 55% with significant difference( P < 0. 05). Conclusion Carboprost tromethamine injection combined with misoprostol tablets can significantly reduce the amount of bleeding in patients with pregnancy postpartum hemorrhage due to uterine atonyand shorten the time of bleeding,with high safety.
Objective To observe the clinical efficacy and safety of carboprost tromethamine injection combined with misoprostol tablets in the treatment of pregnancy postpartum hemorrhage due to uterine atony.Methods A total of 146 patients with pregnancy postpartum hemorrhage due to uterine atony were randomly divided into control and treatment groups with 73 cases per group. Control group was treated with misoprostol 200 μg by rectal administration. Treatment group was treated with carboprost tromethamine 250 μg by the myometrium injection( repeated administration if necessary,but the total amount < 2000 μg),on the basis of control group. The clinical efficacy,bleeding condition,levels of brain natriuretic peptide( BNP) and adverse drug reactions were compared between two groups. Results After treatment,the total effective rates of treatment and control groups were 95. 89%( 70 cases/73 cases)and 86. 31 %( 63 cases/73 cases) with significant difference( P < 0. 05). After treatment,the main indexes of treatment and control groups were compared: volume of postpartum hemorrhage in 2 h were( 219. 75 ± 30. 27) and( 358. 96 ± 49. 84) m L,volume of postpartum hemorrhage in 24 h were( 271. 18 ± 32. 85) and( 463. 25 ± 60. 07) m L,hemostasis time were( 18. 63 ± 2. 59) and( 31. 82 ± 3. 96) min,BNP were( 42. 58 ± 5. 32) and( 86. 64 ± 10. 15) pg·m L~(-1),the differences were statistically significant( all P < 0. 05).The adverse drug reactions of two groups were alimentary tract reaction,heart rate increase,headache and flush. The total incidences of adverse drug reactions in treatment and control groups were 9. 08% and 20. 55% with significant difference( P < 0. 05). Conclusion Carboprost tromethamine injection combined with misoprostol tablets can significantly reduce the amount of bleeding in patients with pregnancy postpartum hemorrhage due to uterine atonyand shorten the time of bleeding,with high safety.
引文
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[3]潘春红.宫缩乏力性产后出血的临床治疗进展[J].右江民族医学院学报,2016,38(4):438-441.
[4]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):554-557.
[5]国家药品不良反应监测中心.常见严重药品不良反应技术规范及评价标准[EB/OL].北京:国家药品不良反应监测中心,2013-12-10[2018-07-06]. http://wenku. baidu. com/view/806c64e9856a561252d36f49. html.
[6] MAIN E K,GOFFMAN D,SCAVONE B M,et al. National partnership for maternal safety consensus bundle on obstetric hemorrhage[J]. Jognn J Obst Gyn Neo,2015,44(4):462-470.
[7]张振.米索前列醇药理作用与临床应用分析[J].世界最新医学信息文摘,2015,15(38):34.
[8]杨虎.卡前列素氨丁三醇与米索前列醇防治宫缩乏力性产后出血的效果比较[J].今日药学,2017,27(1):30-32.
[9]孙芙蓉.米索前列醇联合卡前列素氨丁三醇治疗顽固性产后出血的疗效及不良反应观察[J].临床医学研究与实践,2016,1(27):138-139.
[2] SAY L,CHOU D,GEMMILL A,et al. Global causes of maternal death:a WHO systematic analysis[J/OL]. Lancet Glob Health,2014,2(6):e323-e333. 2014-05-05[2018-08-10].https://linkinghub. elsevier. com/retrieve/pii/S2214-109X(14)70227-X.
[3]潘春红.宫缩乏力性产后出血的临床治疗进展[J].右江民族医学院学报,2016,38(4):438-441.
[4]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):554-557.
[5]国家药品不良反应监测中心.常见严重药品不良反应技术规范及评价标准[EB/OL].北京:国家药品不良反应监测中心,2013-12-10[2018-07-06]. http://wenku. baidu. com/view/806c64e9856a561252d36f49. html.
[6] MAIN E K,GOFFMAN D,SCAVONE B M,et al. National partnership for maternal safety consensus bundle on obstetric hemorrhage[J]. Jognn J Obst Gyn Neo,2015,44(4):462-470.
[7]张振.米索前列醇药理作用与临床应用分析[J].世界最新医学信息文摘,2015,15(38):34.
[8]杨虎.卡前列素氨丁三醇与米索前列醇防治宫缩乏力性产后出血的效果比较[J].今日药学,2017,27(1):30-32.
[9]孙芙蓉.米索前列醇联合卡前列素氨丁三醇治疗顽固性产后出血的疗效及不良反应观察[J].临床医学研究与实践,2016,1(27):138-139.