[关键词]
[摘要]
目的 探讨垂体后叶素联合卡前列素氨丁三醇和缩宫素治疗胎盘早剥产后大出血中的临床疗效。方法 选择2015年6月—2018年6月焦作市妇幼保健院56例胎盘早剥产后大出血患者作为研究对象,根据随机动态原则将患者分为对照组(n=28)和观察组(n=28)。对照组在胎儿娩出后深部肌肉注射卡前列素氨丁三醇注射液,250 μg/次,同时静脉滴注缩宫素注射液,10 U/次,对于止血效果不佳者再次给予卡前列素氨丁三醇深部肌肉注射。观察组在对照组的基础上将6 U垂体后叶注射液,溶于0.9%氯化钠溶液20 mL中于子宫肌层局部注射。比较两组患者第三产程时间、产后出血及止血情况;凝血指标变化;住院时间、血红蛋白水平以及不良事件发生情况。结果 治疗后,观察组第三产程时间和止血时间显著短于对照组,产后15 min、2 h及24 h时的出血量少于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组的D-二聚体(D-D)、活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、凝血酶时间(TT)均显著降低,纤维蛋白原(Fbg)水平显著升高(P<0.05);治疗后,观察组各凝血指标水平优于对照组(P<0.05)。与对照组治疗后相比,观察组患者住院时间显著缩短,血红蛋白水平显著升高,两组比较差异具有统计学意义(P<0.05)。治疗后,观察组不良事件发生率为10.71%,显著低于对照组的39.29%,两组比较差异具有统计学意义(P<0.05)。结论 垂体后叶素联合卡前列素氨丁三醇和缩宫素有助于改善凝血功能,减少产后出血量及不良事件发生率,缩短住院时间,在胎盘早剥产后大出血治疗中具有较高的应用价值。
[Key word]
[Abstract]
Objective To investigate the clinical effect of pituitrin combined with carboprost tromethamine in treatment of massive hemorrhage after placental abruption. Methods 56 patients with postpartum massive hemorrhage after placental abruption in Jiaozuo City Maternal and Child Health Hospital from June 2015 to June 2018 were selected as research objects. According to the random dynamic principle, subjects were divided into the control group (n=28) and the observation group (n=28). In the control group, after the birth of the fetus, patients were given a deep intramuscular injection of Carboprost Tromethamine Injection, 250 μg/ time, and iv administered with Oxytocin Injection at the same time, 10 U/time. For those with poor hemostatic effect, Carboprost Tromethamine Injection was injected with the deep muscle again. Patients in the observation group were injected Posterior Pituitary Injection into the myometrium on the basis of control group, 6 U was dissolved into 0.9% sodium chloride solution 20 mL. The third stage of labor, postpartum hemorrhage and hemostasis were compared between two groups. And the changes of coagulation index, the length of stay, hemoglobin levels, and adverse events in two groups were compared. Results After treatment, the time of the third stage of labor and hemostasis in the observation group was significantly shorter than those in the control group, and the amount of bleeding at 15 min, 2 h and 24 h were less than those in the control group, the difference between two groups was statistically significant (P<0.05). After treatment, D-D, APTT, PT and TT in two groups were significantly decreased, while Fbg level were significantly increased (P<0.05). After treatment, the coagulation indexes in the observation group were better than those in the control group (P<0.05). Compared with the control group, the length of stay in the observation group was significantly shortened, and the hemoglobin level was significantly increased after treatment, the difference between two groups was statistically significant (P<0.05). After treatment, the incidence of adverse events in the observation group was 10.71%, which was significantly lower than 39.29% in the control group, the difference between two groups was statistically significant (P<0.05). Conclusion Pituitrin combined with carboprost tromethamine helps to improve blood coagulation, reduce postpartum hemorrhage, and the incidence of adverse events, and shorten hospital stay. It has a high application value in treatment of massive hemorrhage after placental abruption.
[中图分类号]
R984
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