目的 研究氨甲环酸注射液联合垂体后叶注射液治疗难治性产后出血的临床疗效。方法 选取2016年12月-2019年12月在洛阳东方医院治疗的70例难治性产后出血患者，将所有患者随机分为对照组和治疗组，每组各35例。对照组患者静脉滴注垂体后叶注射液，6 U溶于5%葡萄糖注射液500 mL中，控制滴速为0.02~0.04 U/min。治疗组患者在对照组基础上缓慢静脉滴注氨甲环酸注射液，1 g溶于5%葡萄糖注射液500 mL中。观察两组临床疗效，比较两组的出血量、止血时间和恶露持续时间、血液学指标D-二聚体（D-D）、血红蛋白（Hb）、血浆纤维蛋白原（FIB）和血清因子一氧化氮合酶（NOS）和一氧化氮（NO）、水平。结果 治疗后，治疗组的总有效率为97.14%，对照组的总有效率为82.86%，治疗组总有效率显著高于对照组（P<0.05）。治疗后，治疗组2 h、2~24 h出血量、止血时间和恶露持续时间明显低于对照组（P<0.05）。治疗后，两组血清D-D、Hb和FIB水平显著降低（P<0.05），且治疗组D-D、Hb和FIB水平降低程度较大（P<0.05）。治疗后，两组患者血清NOS和NO水平显著降低（P<0.05），且治疗组血清NOS和NO水平降低程度较大P<0.05）。结论 氨甲环酸注射液联合垂体后叶注射液治疗难治性产后出血可以改善临床症状，降低血清NOS、NO、D-D、Hb和FIB水平。

Objective To study the efficacy of Tranexamic Acid Injection combined with Posterior Pituitary Injection in treatment of refractory postpartum hemorrhage. Methods Patients (70 cases) with refractory postpartum hemorrhage in Luoyang Dongfang Hospital from December 2016 to December 2019 were randomly divided into control and treatment groups, and each group had 35 cases. Patients in the control group were iv administered with Posterior Pituitary Injection, 6 U added into 5% glucose solution 500 mL, and the dropping rate was controlled at 0.02-0.04 U/min. Patients in the treatment group were iv administered with Tranexamic Acid Injection on the basis of the control group, 1 g added into 5% glucose solution 500 mL. After treatment, the clinical efficacies were evaluated, and the bleeding volume, the hemostasis time, the lochia duration, the levels of hematological indicator D-D, Hb, FIB, and serum factors NOS and NO in two groups were compared. Results After treatment, the total effective rate of the treatment group was 97.14%, and that of the control group was 82.86%, and the total effective rate of the treatment group was significantly higher than that of the control group (P < 0.05). After treatment, the bleeding volume, hemostasis time, and lochia duration in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the serum levels of D-D, Hb, and FIB in two groups were significantly decreased (P < 0.05), and the serum levels of D-D, Hb, and FIB in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the serum levels of NOS and NO in two groups were significantly decreased (P < 0.05), and the serum levels of NOS and NO in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Tranexamic Acid Injection combined with Posterior Pituitary Injection in treatment of refractory postpartum hemorrhage can improve the clinical symptoms, reduce the serum levels of NOS, NO, D-D, Hb, and FIB.

R984

河南省医学科技攻关计划项目（201702091）