目的 探讨蛇毒血凝酶联合缩宫素治疗高龄产妇剖宫产术后出血的临床疗效。方法 选取2016年1月—2018年4月宜昌市第二人民医院收治的剖宫产术后出血的高龄产妇376例，随机分为对照组和治疗组，每组各188例。对照组在胎儿娩出后立即向切口上方的子宫肌壁注射缩宫素注射液20 U，然后将20 U缩宫素注射液加入0.9%氯化钠注射液250 mL中，静脉滴注，以后每天静脉滴注缩宫素20 U。治疗组在对照组的基础上在胎儿娩出后立即向切口上方的子宫肌壁注射蛇毒血凝酶注射液1 U，以后每天肌肉注射蛇毒血凝酶注射液1 U，两组均连续治疗3 d。观察两组患者的临床疗效，同时比较两组患者的产后出血率、出血量、第三产程时间、恶露持续时间、住院时间、子宫底高度、D-二聚体、血红蛋白（Hb）、血浆纤维蛋白原（FIB）水平发生情况。结果 治疗后，对照组和治疗组的总有效率分别是77.13%、89.36%，两组比较差异具有统计学意义（P<0.05）。治疗后，治疗组产后出血率、出血量、第三产程时间、恶露持续时间、住院时间、子宫底高度均显著小于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组D-二聚体、Hb、FIB水平均显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；且治疗后治疗组D-二聚体、Hb、FIB水平明显低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 蛇毒血凝酶联合缩宫素治疗剖宫产术后出血具有较好的临床疗效，可显著降低术中及术后出血量和出血率，缩短第三产程时间、恶露持续时间，促进子宫复旧。

Objective To observe the clinical effect of hemocoagulase combined with oxytocin in treatment of postpartum hemorrhage after cesarean section in older maternal. Methods Patients (376 cases) with postpartum hemorrhage after cesarean section in Second People's Hospital of Yichang City from January 2016 to April 2018 were randomly divided into control and treatment groups, and each group had 188 cases. Patients in the control group were iv administered with Oxytocin Injection 20 U in uterine muscle wall above the incision after the foetus parturition, and iv drip with Oxytocin Injection, 20 U added into 0.9% Sodium Chloride Injection 250 mL, every day. Patients in the treatment group were iv administered with Hemocoagulase Injection 1 U in uterine muscle wall above the incision after the foetus parturition, and then im administered with Hemocoagulase Injection 1 U every day. Patients in two groups were treated for 3 d. After treatment, the clinical efficacy was evaluated, and postpartum hemorrhage rate, bleeding volume, third process time, lochia duration, hospital stay, postpartum uterine fundus height, D-dimer, hemoglobin (Hb), and fibrinogen (FIB) in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 77.13% and 89.36%, and there were differences between two groups (P<0.05). After treatment, postpartum hemorrhage rate, bleeding volume, third process time, lochia duration, hospital stay, and postpartum uterine fundus height in the treatment group were significantly lower than those in the control group, and there were differences between two groups (P<0.05). After treatment, D-dimer,Hb, and FIB in two groups were significantly decreased, and there were differences in the same group (P<0.05). After treatment, D-dimer, Hb, and FIB levels in the treatment group were significantly lower than those in the control group, and there were differences between two groups (P<0.05). Conclusion Hemocoagulase combined with oxytocin has clinical curative effect in treatment of postpartum hemorrhage after cesarean section, can significantly reduce bleeding volume and postpartum hemorrhage rate, shorten third process time and lochia duration, and accelerate the recovery of uterus.

湖北省自然科学基金资助项目（[2015CFB574]）