宫腔填塞联合米索前列醇预防高危因素剖宫产产后出血的临床疗效观察

摘要

目的:探讨宫腔填塞联合米索前列醇预防高危因素剖宫产产后出血的临床疗效.方法:有剖宫产产后出血高危因素产妇125例,随机分为A组(n=63)和B组(n=62).A、B组所有患者均于胎儿娩出后给予子宫壁肌肉内注射缩宫素20 U、静脉滴注缩宫素10U,手术结束后给予肛塞米索前列醇400μg.但A组另于胎盘娩出、宫腔清理后给予纱布填塞宫腔.观察术中、术后2h、术后24h出血量及手术时间、产褥感染、不良反应情况.结果:A组术中、术后2h、术后24 h出血量分别为:150.3±42.3 ml,282.2±55.2 ml,355.8±92.5 ml;产后出血率为1.59％;B组术中、术后2h、术后24 h出血量分别为:206.7±33.9 ml,456.2±75.3 ml,568.4±83.2 ml;产后出血率为12.90％;A组出血量及产后出血发生率明显低于B组(P＜0.05),而手术时间、产褥感染、不良反应情况组间无统计学差异(P＞0.05).结论:宫腔填塞纱布联合米索前列醇预防高危因素剖宫产产后出血疗效显著,可明显减少产后出血发生率.%Objective:To investigate the clinical curative effect of gauze packing combined with misoprostol plugging preventing postpartum hemorrhage of high-risk in cesarean section.Methods:A total of 125 puerperas with the risk factors of postpartum hemorrhage in cesarean section were randomly divided into group A (n=63) and group B (n=62).Both group A and group B were given 20 U oxytocin injected into the intramural uterine muscle and given 10 U oxytocin by intravenously guttae after delivery of fetus combined with misoprostol 0.4 mg plugging in anus after the surgery.On the basis of this,gauze packing in uterine cavity were aplied in group A after placental expulsion and cleanning up the uterine cavity.The average volume of bleeding during an operation or in 2 h,24 h after operation,postpartum hemorrhage and operative time,puerperal infection,adverse reaction between the two groups were observed and analyzed.Results:The average volume of bleeding during these operations or in 2 h and 24 h after operations of group A were 150.3 ± 42.3 ml,282.2 ± 55.2 ml,355.8 ± 92.5 ml,postpartum hemorrhage ratio was 1.59％.The average volume of bleeding during these operations or in 2 h and 24 h after operations of group B were 206.7 ± 33.9 ml,456.2 ± 75.3 ml,568.4 ± 83.2 ml; postpartum hemorrhage ratio was 12.90％.The volume of bleeding during these operations or in 2 h,24 h after operations and the rate of postpartum hemorrhage between the two group puerperas were statistically significant (P＜0.05).However,operative time,puerperal infection,apparent adverse reaction between the two groups were not significantly different (P＞0.05).Conclusion:Combined gauze packing and misoprostol plugging could effectively reduce the volume of bleeding and prevent postpartum hemorrhage in cesarean section.