卡前列甲酯栓联合葡萄糖酸钙防治瘢痕子宫阴道分娩产后出血的临床研究
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摘要
目的探讨卡前列甲酯栓联合葡萄糖酸钙防治瘢痕子宫阴道分娩产后出血的临床效果。方法选择2016年1月至2017年5月涿州市医院收治的瘢痕子宫经阴道分娩产妇100例,根据随机数字表法将其分为观察组和对照组,各50例。对照组产妇给予缩宫素20 IU静注;观察组产妇在使用缩宫素的基础上给予卡前列甲酯栓1 mg舌下含服,并联合应用10%葡萄糖酸钙1 g静注。观察产妇的生命体征和不良反应,统计产后出血率,比较两组产妇的第三产程时间,产后2 h、24 h出血量。采用凝血酶原时间(prothrombin time,PT)、部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)和D-二聚体(Ddimer,D-D)比较两组产妇的凝血功能。结果观察组发生产后出血1例,对照组6例,观察组产后出血发生率明显低于对照组,差异有统计学意义(P <0. 05)。观察组第三产程时间及产后2 h、24 h出血量[(7. 10±3. 95) min,(139. 22±33. 05) m L,(211. 63±40. 90) m L)]均少于对照组[(9. 61±4. 72) min,(214. 80±41. 17)m L,(302. 57±55. 38) m L](P <0. 05)。观察组产妇APTT明显低于对照组[(23. 98±4. 42) s vs (32. 56±5. 30) s],FIB指标则明显高于对照组[(6. 16±1. 88) g/L vs (3. 22±1. 59) g/L],差异有统计学意义(P <0. 05)。两组产妇不良反应发生率比较,差异无统计学意义(P> 0. 05)。结论卡前列甲酯栓联合葡萄糖酸钙防治瘢痕子宫阴道分娩产后出血的效果确切,安全性高,明显减少产后出血,值得临床推广。
Objective To investigate the clinical effect of caproprostase combined with calcium gluconate in prevention and treatment of postpartum hemorrhage in vaginal delivery of scar uterus. Methods 100 cases of vaginal delivery of the scar uterus admitted to the Zhuozhou City Hospital from January 2016 to May 2017 were divided into observation group and control group according to the random number table method,with 50 cases in each. The control group received oxytocin 20 IU intravenous injection; on the basis of the use of oxytocin,the observation group received the carboprostol suppository 1 mg sublingual administration,combined with10 % calcium gluconate 1 g intravenously. Observed the vital signs and adverse reactions of the maternal,counted the postpartum hemorrhage rate,compared the third stage of labor and the amount of bleeding 2 hours and 24 hours after delivery in the two groups of women. Compared the prothrombin time( PT),activated partial thromboplastin time( APTT),fibrinogen( FIB) and D-dimer( D-D) of maternal coagulation function. Results One case of postpartum hemorrhage occurred in the observation group,and 6 cases occurred in the control group. The incidence of postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the difference was statistically significant( P < 0. 05). The third stage of labor in the observation group and the amount of bleeding at 2 h and 24 h after birth [( 7. 10 ± 3. 95) min,( 139. 22 ± 33. 05) m L,( 211. 63 ± 40. 90) m L) ] were significantly less than the control group [( 9. 61 ± 4. 72) min,( 214. 80 ± 41. 17) m L,( 302. 57 ± 55. 38) m L]( P < 0. 05). The maternal APTT[( 23. 98 ±4. 42) s]was significantly lower in the observation group than in the control group [( 32. 56 ±5. 30) s],and the FIB index was significantly higher than the control group [( 6. 16 ± 1. 88) g/L vs( 3. 22 ± 1. 59) g/L ],the difference was statistically significant( P < 0. 05). There were no significant differences in maternal adverse reactions between the two groups( P > 0. 05).Conclusion Carboprostol combined with calcium gluconate for the prevention and treatment of postpartum hemorrhage in vaginal delivery of scar uterus is safe and effective,and significantly reduces postpartum hemorrhage. It is worthy of clinical application.
Objective To investigate the clinical effect of caproprostase combined with calcium gluconate in prevention and treatment of postpartum hemorrhage in vaginal delivery of scar uterus. Methods 100 cases of vaginal delivery of the scar uterus admitted to the Zhuozhou City Hospital from January 2016 to May 2017 were divided into observation group and control group according to the random number table method,with 50 cases in each. The control group received oxytocin 20 IU intravenous injection; on the basis of the use of oxytocin,the observation group received the carboprostol suppository 1 mg sublingual administration,combined with10 % calcium gluconate 1 g intravenously. Observed the vital signs and adverse reactions of the maternal,counted the postpartum hemorrhage rate,compared the third stage of labor and the amount of bleeding 2 hours and 24 hours after delivery in the two groups of women. Compared the prothrombin time( PT),activated partial thromboplastin time( APTT),fibrinogen( FIB) and D-dimer( D-D) of maternal coagulation function. Results One case of postpartum hemorrhage occurred in the observation group,and 6 cases occurred in the control group. The incidence of postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the difference was statistically significant( P < 0. 05). The third stage of labor in the observation group and the amount of bleeding at 2 h and 24 h after birth [( 7. 10 ± 3. 95) min,( 139. 22 ± 33. 05) m L,( 211. 63 ± 40. 90) m L) ] were significantly less than the control group [( 9. 61 ± 4. 72) min,( 214. 80 ± 41. 17) m L,( 302. 57 ± 55. 38) m L]( P < 0. 05). The maternal APTT[( 23. 98 ±4. 42) s]was significantly lower in the observation group than in the control group [( 32. 56 ±5. 30) s],and the FIB index was significantly higher than the control group [( 6. 16 ± 1. 88) g/L vs( 3. 22 ± 1. 59) g/L ],the difference was statistically significant( P < 0. 05). There were no significant differences in maternal adverse reactions between the two groups( P > 0. 05).Conclusion Carboprostol combined with calcium gluconate for the prevention and treatment of postpartum hemorrhage in vaginal delivery of scar uterus is safe and effective,and significantly reduces postpartum hemorrhage. It is worthy of clinical application.
引文
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[7]张丽,杨鲜.剖宫产术后瘢痕子宫妊娠的中晚期引产方式及效果分析[J].检验医学与临床,2016,13(3):371-373.
[8]赵亚宁,王军.卡前列甲酯栓在剖宫产术中预防产后出血的临床观察[J].陕西医学杂志,2013,42(2):220-221.
[9]黄慧娟.舌下含服卡前列甲酯栓对剖宫产妇产后出血的临床预防效果研究[J].中国医药指南,2017,15(32):159-160.
[10]Uncu Y,Karahasan M,Uyaniklar,et al.Prophylactic misoprostol for the prevention of postpartum hemorrhage:a randomized controlled trial[J].Eur Rev Med Pharmacol Sci,2015,19(1):15-22.
[2]赵相娟,张梅娜,张涛,等.产后出血的影响因素分析及预测[J].中国妇产科临床杂志,2012,13(2):108-111.
[3]张丽,杨鲜.产后出血的早期识别及相关因素的临床研究[J].检验医学与临床,2016,13(4):487-489.
[4]陈寒波.卡前列甲酯栓对产妇产后出血的预防效果及安全性评价[J].实用药物与临床,2014,17(2):240-242.
[5]张志敏,杨玉秀,张海娟,等.瘢痕子宫再次妊娠分娩方式的探讨[J].河北医科大学学报,2014,7(9):1067-1069.
[6]O Parant,Paul Guerby,F Bayoumeu.Obstetric and anesthetic specificities in the management of a postpartum hemorrhage(PPH)associated with cesarean section[J].J Gynecol Obstet Biol Reprod(Paris),2014,43(10):1104-1122.
[7]张丽,杨鲜.剖宫产术后瘢痕子宫妊娠的中晚期引产方式及效果分析[J].检验医学与临床,2016,13(3):371-373.
[8]赵亚宁,王军.卡前列甲酯栓在剖宫产术中预防产后出血的临床观察[J].陕西医学杂志,2013,42(2):220-221.
[9]黄慧娟.舌下含服卡前列甲酯栓对剖宫产妇产后出血的临床预防效果研究[J].中国医药指南,2017,15(32):159-160.
[10]Uncu Y,Karahasan M,Uyaniklar,et al.Prophylactic misoprostol for the prevention of postpartum hemorrhage:a randomized controlled trial[J].Eur Rev Med Pharmacol Sci,2015,19(1):15-22.