目的 探究妇康丸联合卡前列素氨丁三醇治疗产后宫缩乏力性出血的临床效果与安全性。方法 选取2021年9月—2023年9月在郑州大学第五附属医院分娩后出现宫缩乏力性出血的产妇116例，根据治疗方案的差异分成对照组和治疗组，每组各58例。对照组子宫体注射卡前列素氨丁三醇注射液，首次注射剂量为250 μg，15 min后仍见活动性出血则再次注射250 μg，总剂量控制在2 mg以内。治疗组额外口服妇康丸，首次9 g，相隔6 h后再服用9 g，此后每日早晚各服9 g。两组均进行为期5 d的治疗。观察两组患者临床疗效，比较治疗前后两组患者24 h内出血量、止血时间和住院时间，血清25-羟维生素D[25-(OH) D]、D-二聚体（D-D）和转化生长因子-β1（TGF-β1）水平，及子宫复旧情况和不良反应情况。结果 治疗后，对照组和治疗组临床总有效率分别为86.21%、96.55%，两组比较差异具有统计学意义（P＜0.05）。治疗后，治疗组产妇24 h内出血量、止血时间及住院时间均明显短于对照组（P＜0.05）。治疗后，两组产妇血清25-(OH)D和TGF-β1水平显著升高，而血清D-D水平均显著降低（P＜0.05），且治疗组各指标改善显著优于对照组（P＜0.05）。治疗后，两组产妇子宫三径之和和宫底高度均显著降低（P＜0.05），且治疗组在各指标改善上显著优于对照组（P＜0.05）。治疗过程中，对照组不良反应发生率为34.48%，明显高于治疗组的17.24%（P＜0.05）。结论 妇康丸联合卡前列腺素氨丁三醇治疗产后宫缩乏力性出血疗效显著，不仅能够显著改善产妇出血症状并缩短住院时间，同时还能够促进子宫复旧和血清学指标的恢复。

Objective To explore the therapeutic effect and safety of Fukang Pills and carboprost tromethamine in treatment of postpartum uterine atony and hemorrhage. Methods Patients (116 cases) with postpartum uterine atony and hemorrhage in the Fifth Affiliated Hospital of Zhengzhou University from September 2021 to September 2023 were divided into control and treatment group based on different treatments, and each group had 58 cases. Patients in the control group were iv administered with Carboprost Tromethamine Injection within the uterus, the first injection dose was 250 μg, if active bleeding was still seen 15 min later, 250 μg was injected again, the total dose was controlled within 2 mg. Patients in the treatment group were po administered with Fukang Pills on the basis of the control group, the first time was 9 g, followed by 9 g 6 h apart, and then 9 g for twice daily. Patients in two groups were treated for 5 d. After treatment, the clinical evaluations were evaluated, the 24 h bleeding volume, hemostasis time, inpatient duration, serum 25-(OH)D, D-D, and TGF-β1 levels, postpartum uterus regression and adverse reactions in two groups before and after treatment were compared. Results After treatment, the total clinical effective rates of the control group and the treatment group were 86.21% and 96.55%, respectively, and the difference between the two groups was statistically significant (P < 0.05). After treatment, the amount of bleeding in 24 h, hemostasis time, and hospital stay in the treatment group were significantly shorter than those in the control group (P < 0.05). After treatment, the levels of serum 25-(OH)D and TGF-β1 of parturients in both groups were significantly increased, while the level of serum D-D was significantly reduced (P < 0.05). And the levels of these indicators in the treatment group were better than those in the control group (P < 0.05). After treatment, the sum of three uterine diameters and fundal height of parturients in both groups were significantly reduced, and which in the treatment group were significantly lower than those in the control group (P < 0.05). During treatment, the incidence of adverse reactions (34.48%) in the control group was significantly higher than that (17.24%) in the treatment group (P < 0.05). Conclusion The combination of Fukang Pills and carboprostaglandin tromethamine has a significant therapeutic effect on postpartum uterine atony and hemorrhage, which can not only significantly improve the bleeding symptoms of parturients and shorten hospital stay, but also promote uterine involution and the recovery of serological indicators.

R984

河南省医学科技攻关计划联合共建项目(LHGJ20220567)