不同时机使用卡前列素氨丁三醇对预防产后出血的效果比较

摘要

目的：观察不同时机使用卡前列素氨丁三醇对预防产后出血的效果。方法：对2014年7月-2016年7月于本院生产且产后有出血倾向的病例2433例的临床资料进行回顾性分析，根据卡前列素氨丁三醇使用时机分为观察组805例和对照组1628例。两组产妇在胎儿娩出后静脉输注复方氯化钠500 mL+催产素20 U，同时观察组直接三角肌注射卡前列素氨丁三醇250μg；对照组在催产素止血失效且顺产出血超过300 mL，剖宫产出血超过600 mL时，注射卡前列素氨丁三醇250μg。根据两组产妇的后续出血量决定是否重复使用卡前列素氨丁三醇或联合其他止血方法。比较两组产妇产后出血发生率、产后2 h与24 h出血量、需要联合其他止血方法及不良反应发生情况。结果：观察组出血发生率为3.7%，对照组出血发生率为3.9%，两组比较差异无统计学意义（P>0.05）；观察组产后2 h和24 h出血量均显著少于对照组，差异均有统计学意义（P<0.05）；观察组联合使用子宫止血球囊2例，对照组使用子宫止血球囊19例，两组比较差异有统计学意义（P<0.05）；两组均有少数产妇出现轻微的不良反应，经对症处理后好转。结论：卡前列素氨丁三醇可有效减少有产后出血倾向的产妇产后2、24 h出血量，减少联合使用子宫止血球囊，降低了患者的费用，且安全有效。%Objective:To observe the effect of the use of Carboprost Tromethamine Injection in the prevention of postpartum hemorrhage.Method:2433 patients with postpartum bleeding tendency in our hospital from January 2014 to July 2016 in our hospital were retrospectively analyzed,according to the use time of Carboprost Tromethamine Injection,all patients were divided into observation group(n=805) and control group(n=1628).All parturient in postpartum were given compound sodium chloride 500 mL+20 U oxytocin by intravenous infusion,and the observation group received 250 μg Carboprost Tromethamine Injection by directly deltoid injection.If the control group had oxytocin hemostatic failure and bleeding more than 300 mL vaginal delivery,cesarean section hemorrhage more than 600 mL,the control group received 250 μg Carboprost Tromethamine Injection.According to the two groups of maternal follow-up blood loss to decide whether to repeat the use of Carboprost Tromethamine Injection or combined with other hemostatic methods.Comparison of two groups of maternal postpartum hemorrhage incidence,2 hours,24 hours of blood loss,needed to combine other hemostatic methods and adverse reactions.Result:The incidence of bleeding in the observation group was 3.7%,the incidence of bleeding in the control group was 3.9%,there was no significant difference between the two groups(P>0.05). The observation group postpartum vagina and uterus bleeding and 2 h and 24 h were significantly lower than those in the control group,the differences were statistically significant(P<0.05).The observation group with 2 cases of uterine bleeding balloon,the control group used uterine hemostatic balloon in 19 cases,the difference was statistically significant (P<0.05).The two groups had a small number of maternal adverse reactions,improved after symptomatic treatment.Conclusion:Carboprost Tromethamine Injection can be effectively and safe reduce postpartum 2 hours and 24 hours haemorrhage for parturient with bleeding tendency,reduce the combination of uterine bleeding balloon,reduce the cost of the patients,and it is safe and effective.