卡前列甲酯栓对减少普通足月阴道分娩患者产后出血的临床疗效

摘要

目的 观察米索前列醇、缩宫素鼻喷剂及卡前列甲酯栓对普通足月阴道分娩患者产后出血量的临床疗效及其对雌激素、一氧化氮(NO)及一氧化氮合酶(NOS)的影响.方法 收集我院收治的普通足月阴道分娩的患者600例,随机分为A组、B组和C组,每组各200例.A组给予缩宫素鼻喷剂,每喷0.1 mL,每侧鼻孔各2喷,每日2次,B组舌下含化米索前列醇200嵋,C组给予卡前列甲酯栓1 mg,塞肛.治疗后,比较3组患者血清中雌二醇(E2)、NO及NOS水平、出血量,观察3组患者的临床疗效和药物不良反应发生情况.结果 治疗后,A组总有效率为76.50％(153/200例),B组为86.00％(172/200例),C组为90.50％(181/200例),C组与A组比较,差异有统计学意义(P＜0.05).治疗后,A、B、C组E2分别为(14.75 ±2.09),(17.63 ±2.15),(21.82 ±3.09)nmol·L-1;NO分别为(107.83±11.21),(92.42±10.17),(79.25±9.89)nmol·L-1;NOS分别为(25.64±3.11),(22.56±3.05),(19.63 ±2.28)nmol·L-(P＜0.05).A、B、C组2h内出血量分别为(712.43±40.85),(632.43 ±42.77),(580.74±37.64)mL;2～ 24 h出血量分别为(138.92±17.86),(126.94±12.93),(103.85±11.13) mL(P＜0.05).A组药物不良反应有鼻腔刺激反应、鼻出血,药物不良反应发生率为1.50％(3/200例);B组药物不良反应有轻度恶心、呕吐、眩晕,药物不良反应发生率为2.50％(5/200例);C组药物不良反应有腹泻、恶心呕吐,药物不良反应发生率为2.00％(4/200例),差异无统计学意义(P＞0.05).结论 与米索前列醇、缩宫素鼻喷剂治疗比较,卡前列甲酯栓能够更显著提高普通足月阴道分娩患者血清E2水平,降低血清NO、NOS水平,减少出血量,且安全性较高.%Objective To analysis the effect of misopmstol,oxytocin nasal spray and carboprost methylate suppositorites on estrogen,nitric oxide (NO),nitric oxide synthase (NOS) and clinical efficacy in patients with general term vaginal delivery.Methods A total of 600 patients with postpartum hemorrhage were randomly divided into group A,group B and group C,200 cases in each group.Group A was given oxytocin nasal spray,per nostril 0.1 mL,twice a day,group B was given misoprostol,200 μg sublingual,group C received carboprost methylate suppositorites 1 mg,anus.After treatment,the serum levels of estradiol (E2),nitric oxide (NO) and nitric oxide synthase (NOS),bleeding volume,clinical efficacy,adverse drug reactions were compared in three groups.Results After treatment,the total effective rates in group A,B and C were 76.50％ (153/200 cases),86.00％ (172/200 cases),90.50％ (181/200 cases),total effective rate of group C significantly higher than group A (P ＜ 0.05).After treatment,estradiol levels of group A,B,C were (14.75 ±2.09),(17.63 ±2.15),(21.82 ±3.09) nmol · L-1.Levels of NO in group A,B,C were (107.83 ± 11.21),(92.42 ± 10.17),(79.25 ±9.89) nmol · L-1.Levels of NOS in group A,B,C were (25.64 ±3.11),(22.56±3.05),(19.63 ±2.28) nmol · L-1(P ＜0.05).And 2 h bleeding volume were (712.43 ± 40.85),(632.43 ± 42.77),(580.74 ± 37.64) mL in group A,B,C;2-24 h bleeding volume were (138.92 ± 17.86),(126.94 ± 12.93),(103.85 ± 11.13) mL in group A,B,C(P ＜0.05).The adverse drug reactions in group A were nasal irritation,nasal bleeding,incidence of adverse drug reactions was 1.50％ (3/200 cases).The adverse drug reactions in group B were mild nausea,vomiting,dizziness,incidence of adverse drug reactions was 2.50％ (5/200 cases).The adverse drug reactions in group C were diarrhea,nausea and vomiting,incidence of adverse drug reactions was 2.00％ (4/200 cases),with no statistical differences (P ＞ 0.05).Conclusions Compared with the treatment of misoprostol and oxytocin nasal spray,the carboprost methylate suppositorites can significantly improve the serum E2 level,reduce serum NO and NOS levels in patients with postpartum hemorrhage and reduce bleeding.