目的 探讨凝血酶联合卡前列素氨丁三醇注射液对宫缩乏力性产后出血患者的止血效果及凝血因子的影响。方法选取2015年1月—2019年12月武安市第一人民医院宫缩乏力性产后出血患者130例作为研究对象，根据治疗方案不同分为对照组（n=62）和观察组（n=68）。对照组自然分娩患者经臀部注射卡前列素氨丁三醇注射液250 μg；剖宫产患者经宫体注射卡前列素氨丁三醇注射液250 μg。若未达止血目的，于15、30 min后再次给药，但总剂量<2 mg。观察组在对照组基础上增加凝血酶冻干粉宫腔灌注治疗，取2 000单位凝血酶＋20 mL生理盐水，缓慢注进宫腔，再将5 mL生理盐水注入导管中拔出导管，无菌纱布堵塞宫颈口。侧卧，抬高臀部，4 h后取出宫颈纱布。观察两组的止血效果，比较患者治疗前、治疗后30 min、1 d的凝血因子［凝血因子Ⅶ（F Ⅶ）、F Ⅷ、F Ⅸ］水平、创面闭合能力［内皮生长因子（VEGF）、内皮生长因子受体-1（VEGFR-1）、内皮生长因子受体-2（VEGFR-2）］、并发症发生率、生理功能恢复情况。结果 治疗后，观察组子宫持续收缩时间长于对照组，止血时间、住院时间短于对照组，阴道出血量（产后2 h、产后24 h）、转手术率低于对照组（P<0.05）。治疗后30 min、1 d血浆F Ⅶ、F Ⅷ、F Ⅸ水平均显著升高（P<0.05），且观察组F Ⅶ、F Ⅷ、F Ⅸ水平显著高于同期对照组，差异有统计学意义（P<0.05）。治疗后30 min、治疗后1 d血清VEGF、VEGFR-1、VEGFR-2水平均显著升高（P<0.05），且观察组血清VEGF、VEGFR-1、VEGFR-2水平显著高于同期对照组，差异有统计学意义（P<0.05）。治疗后，观察组并发症发生率为7.35%，显著低于对照组的20.97%（P<0.05）。治疗后，观察组恶露时间、复潮时间、月经周期均短于对照组，第1次月经量少于对照组（P<0.05）。结论 凝血酶联合卡前列素氨丁三醇注射液可提高宫缩乏力性产后出血患者止血效果，改善凝血因子水平及创面闭合能力，减少并发症的发生，促进生理机能恢复。

Objective To investigate the effect of thrombin combined with carboprost tromethamine on hemostasis and coagulation factors in patients with postpartum hemorrhage caused by uterine weakness. Methods A total of 130 patients with postpartum hemorrhage due to uterine weakness in Wuan First People's Hospital from January 2015 to December 2019 were selected as the research subjects, and were divided into control group (n=62) and observation group (n=68) according to different treatment regimens. Patients in the control group were injected 250 μg Carboprost Tromethamine Injection through hip for patients with natural delivery; 250 μg Carboprost Tromethamine Injection was administered to patients undergoing cesarean section in patients with cesarean section under direct vision. If the hemostasis was not achieved, the drug was given again 15 and 30 min later, but the total dose was less than 2 mg. Patients in the observation group were intrauterine perfusion with Lyophilizing Thrombin Powder on the basis of control group, 2 000 units of thrombin + 20 mL of normal saline were slowly injected into the uterine cavity, then 5 mL of normal saline was injected into the catheter to pull out the catheter, and the cervical orifice was blocked with sterile gauze. Lie on the side, raise the buttocks, and take out the cervical gauze 4 h later. The hemostasis effect of two groups was observed, and the levels of coagulation factor (F Ⅶ, F Ⅷ, and F Ⅸ), wound closure ability (VEGF, VEGFR-1, and VEGFR-2), the incidence of complications, and the recovery of physiological function before treatment and 30 min or 1 d after treatment were compared. Results After treatment, the duration of uterine contraction in the observation group was longer than that in the control group, the hemostasis time and hospitalization time were shorter than those in the control group, the amount of vaginal bleeding (2 h postpartum, 24 h postpartum) and the rate of surgical transfer in the observation group were less than those in the control group (P < 0.05). 30 min and 1 d after treatment, the plasma levels of F Ⅶ, F Ⅷ, and F Ⅸ were significantly increased (P < 0.05), and the levels of F Ⅶ, F Ⅷ, and F Ⅸ in the observation group were significantly higher than those in the control group at the same period, the difference being statistically significant (P < 0.05). After treatment of 30 min and 1 d, the levels of serum VEGF, VEGFR-1, and VEGFR-2 were significantly increased (P < 0.05), and the levels of serum VEGF, VEGFR-1 and VEGFR-2 in the observation group were significantly higher than those in the control group at the same period, with statistical significance (P < 0.05). After treatment, the complication rate of the observation group was 7.35%, which was significantly lower than 20.97% of the control group (P < 0.05). After treatment, lochia time, return to tide time, and menstrual cycle in the observation group were shorter than those in the control group, and the first menstrual volume was less than that in the control group (P < 0.05). Conclusion Thrombin combined with carboprost tromethamine can improve the hemostatic effect of postpartum hemorrhage patients with uterine weakness, improve the level of coagulation factors and wound closure ability, reduce the incidence of complications, and promote the recovery of physiological functions.

R984

河北省医学科学研究重点课题计划项目（20181714）