卡贝缩宫素联合缩宫素预防阴道分娩产后出血效果分析

摘要

Objective To explore carbetocin combine with oxytocin in the prevention of postpartum haemorrhage (PPH) following vaginal delivery. Methods Randomized study was carried out on term, single pregnancy following vaginal delivery. Women with placenta praevia, multiple gestation, GDM, preeclampsia, previous caesarean section, HB <90g/L, and placental abruption were excluded. All 200 cases were randomized to receive either carbetocin combine with oxytocin group ( group A) or oxytocin ( group B). Following delivery of the anterior shoulder of the baby. 20IU oxytocin in 500 ml solution was infusion and 1 mL carbetocin containing 100 microgram carbetocin(group A) or 10 IU oxytocin(group B) given as intramuscularly injection at the end of second stage of labour. 1 h, 1 ~ 2 h and 2 ~ 24 h blood volume of postpartum were collected; prenatal,postpartum 1 h and 2 h pulse and blood pressure of the two groups were recorded. Results There was no difference in the amount of estimated blood loss within 1 h and 1 ~2 h between the two groups. However, there was significant difference in the amount of estimated blood loss within 2~24 h and 24 h between the two groups. The incidence postpartum haemorrhage of group A and B were 6% vs. 8%. There was no difference in birth weight between the two groups. However, there was significant difference in systolic pressure and diastolic pressure during postpartum 2 h. The use of carbetocin was associated with hypertension and maternal tachycardia after delivery, but significant lower incidence of nausea and vomiting. Conclusion Carbetocin combine with oxytocin is a safe, efficacious method in prevention of postpartum haemorrhage following vaginal delivery.%目的 探讨卡贝缩宫素联合缩宫素对足月单胎阴道分娩宫缩乏力性产后出血的预防效果.方法 前瞻性地对足月单胎阴道分娩的产妇进行对照研究,共观察200例,随机分为2组,其中A组100例(阴道分娩卡贝缩宫素联合缩宫素组),胎儿肩部娩出后缩宫素20 IU持续静脉点滴,胎儿娩出后卡贝缩宫素100 μg肌肉注射；B组100例(阴道分娩缩宫素组),胎儿肩部娩出后缩宫素20 IU持续静脉点滴,胎儿娩出后缩宫素10 IU肌肉注射.记录产后1h,1～2h,2～24 h出血量、血压、心率的变化及药物不良反应.结果 两组产妇产后1 h(t =1.46,P＞0.05),1～2h出血量差异均无统计学意义(t=1.19,P＞0.05),A组2～24 h出血量少于B组,差异有统计学意义(t=3.62,P＜0.01),产后24h出血量A组少于B组,差异有统计学意义(t=2.74,P＜0.05).A组和B组产后出血发生率分别为6％ vs.8％,A组和B组产后2h收缩压和舒张压比较,差异均有统计学意义(t=2.74,P＜0.05；t =2.64,P＜0.05),A组产后出现一过性血压升高和心率加快,但未出现明显恶性呕吐.结论 卡贝缩宫素联合缩宫素预防阴道分娩产后出血比单用缩宫素效果更佳,无明显副反应.