目的 探讨益母草膏联合卡前列素氨丁三醇治疗宫缩乏力性产后出血的临床疗效。方法 选取2020年3月—2023年12月咸宁市中心医院收治的118例宫缩乏力性产后出血患者，按随机数字表法将患者分为对照组和治疗组，每组各59例。对照组患者单次子宫肌层注射卡前列素氨丁三醇注射液，250 μg。治疗组在对照组治疗基础上口服益母草膏，10 g/次，2次/d。两组均连续治疗3 d。观察两组临床疗效、出血情况及症状改善时间，比较治疗前后宫底高度、血小板计数（PLT）、红细胞比容（HCT）、纤维蛋白原（FIB）、D二聚体（D-D）水平。结果 治疗后，治疗组总有效率是100.00%，显著高于对照组的89.83%（P＜0.05）。治疗组治疗2、12、24 h的出血量显著少于同期对照组（P＜0.05）；治疗组止血时间显著短于对照组（P＜0.05）。治疗后，治疗组面色苍白、无力、头晕、耳鸣的改善时间均显著短于对照组（P＜0.05）。治疗后，两组宫底高度和DASS-21评分均显著降低（P＜0.05）；治疗后，治疗组宫底高度和DASS-21评分低于对照组（P＜0.05）。治疗后，两组PLT、HCT均显著升高，而FIB、D-D均显著降低（P＜0.05）；治疗后，治疗组PLT、HCT、FIB、D-D改善优于对照组（P＜0.05）。结论 益母草膏联合卡前列素氨丁三醇治疗宫缩乏力性产后出血具有较好的临床疗效，止血效果突出，能有效控制出血量，减轻凝血功能异常，加速产妇失血症状改善及子宫功能和心理恢复，值得临床推广应用。

Objective To explore the clinical efficacy of Yimucao Ointment combined with carboprost tromethamine in treatment of postpartum hemorrhage caused by uterine fatigue. Methods A total of 118 patients with postpartum hemorrhage caused by uterine fatigue admitted to Xianning Central Hospital from March 2020 to December 2023 were selected and divided into control group and treatment group according to random number table method, with 59 cases in each group. Patients in the control group were given a single myometriol injection of Carboprost Tromethamine Injection, 250 μg. Patients in the treatment group were po administered with Yimucao Ointment on the basis of the control group, 10 g/time, twice daily. Both groups were treated continuously for 3 d. The clinical efficacy, bleeding situation and symptom improvement time of the two groups were observed. The height of the posterior fundus, platelet count (PLT), erythrocyte specific volume (HCT), fibrinogen (FIB) and D-dimer (D-D) levels in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 100.00%, which was significantly higher than 89.83% of the control group (P < 0.05). The amount of blood loss in the treatment group at 2, 12, and 24 h was significantly lower than that in the control group (P < 0.05). The hemostatic time of the treatment group was significantly shorter than that of the control group (P < 0.05). After treatment, the improvement time of pallor, weakness, dizziness, and tinnitus in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, fundal height and DASS-21 score were significantly decreased in both groups (P < 0.05). After treatment, the fundal height and DASS-21 score in the treatment group were lower than those in the control group (P < 0.05). After treatment, PLT and HCT were significantly increased, but FIB and D-D were significantly decreased in both groups (P < 0.05). After treatment, the improvement of PLT, HCT, FIB and D-D in the treatment group was better than that in the control group (P < 0.05). Conclusion Yimucao Ointment combined with carboprost tromethamine has good clinical efficacy in treatment of postpartum hemorrhage caused by uterine fatigue, and the hemostatic effect was outstanding, and can effectively control the amount of blood loss, reduce the abnormal coagulation function, accelerate the improvement of maternal blood loss symptoms and uterine function and psychological recovery, which is worthy of clinical application.

R984

广西壮族自治区中医药管理局自筹经费科研项目（GXZYA20220085）