欣母沛預防和治療剖宮產(chǎn)術后出血的臨床觀察

周敏+李琳

【摘要】目的：觀察欣母沛在預防和治療宮縮乏力性剖宮產(chǎn)術后出血中的應用效果。方法：選擇剖宮產(chǎn)術后有產(chǎn)后出血傾向的高危孕婦161例（包括雙胎妊娠、巨大胎兒、前置胎盤），隨機分為兩組。欣母沛組（觀察組83例）：胎兒娩出后立即宮體注射250ug欣母沛；縮宮素組（對照組78例）：胎兒娩出后宮體注射20 U縮宮素。比較兩組術后2h及24h出血量、產(chǎn)后出血發(fā)生率、用藥后起效時間及不良反應發(fā)生情況。結果：觀察組產(chǎn)后2h及24h平均出血量明顯少于對照組，產(chǎn)后出血發(fā)生率低于對照組，差異有統(tǒng)計學意義（P<0.05）；觀察組用藥后起效時間為（4.5±1.0）min，明顯短于對照組的（7.2±1.3）min，差異有統(tǒng)計學意義（P<0.05）；觀察組不良反應發(fā)生率為3.61%（3/83），明顯低于對照組的12.82%（10/78），差異有統(tǒng)計學意義（P<0.05）。結論：預防性使用欣母沛有助于減少剖宮產(chǎn)術產(chǎn)后出血，起效時間快，安全性高，可在臨床上推廣。

【關鍵詞】欣母沛；剖宮產(chǎn)；產(chǎn)后出血

【Abstract】Objectives： To observe the application effect of hemabate on preventing and treating cesarean section postpartum hemorrhage caused by uterine atony. Methods：161 pregnant women with high risk factors of postpartum hemorrhage （twin pregnancy， macrosomia and placenta praevia） were selected and divided randomly into two groups： the Hemabate Group （the study group） which included 83 cases， and the Oxytocin Group （the control group） which included 78 cases. The study group was given hemabate of 250μg into uterine muscle after delivery， while the control group was injected with oxytocin 20U into uterine muscle immediately after delivery. The bleeding volume at 2h and 24h， the incidence of postpartum hemorrhage， the onset time and adverse reactions of the two groups were compared. Results： The average blood loss at 2h and 24 h in the observation group was significantly less than the control group， and the incidence of postpartum hemorrhage was lower the control group， with statistically significant difference （P <0.05）. The onset time of the observation group was （4.5±1.0） min， significantly shorter than the control group of （7.2±1.3） min， with statistical significance （P <0.05）. The incidence of adverse reactions in observation group was 3.61% （3/83）， significantly lower than the control group of 12.82% （10/78）， with statistically significant difference （P <0.05）. Conclusion： Preventive use of hemabate can reduce postpartum hemorrhage in cesarean section， which is safe， acting fast and worth promotion in clinic.

【Key words】Hemabate； Cesarean section； Postpartum hemorrhage

【中圖分類號】R716.46【文獻標志碼】A

產(chǎn)后出血是指胎兒娩出后24h內(nèi)失血量>500mL，屬于孕產(chǎn)婦分娩期嚴重并發(fā)癥，發(fā)生率約占分娩總數(shù)的2%～3%[1]。剖宮產(chǎn)術中孕婦存在羊水過多、雙胎妊娠、前置胎盤、巨大胎兒等產(chǎn)后出血高危因素時，術中及術后極易發(fā)生產(chǎn)后出血。以往治療主要采用縮宮劑（縮宮素、麥角新堿），再配合按摩子宮，效果欠佳時子宮動脈結扎、髂內(nèi)動脈結扎，甚至子宮切除，創(chuàng)傷較大，多數(shù)患者難以接受。本文對剖宮產(chǎn)術中存在產(chǎn)后出血高危因素的孕婦采用宮體注射縮宮素及欣母沛治療，對其進行對照分析。現(xiàn)報告如下。

1資料和方法

1.1一般資料

選擇我院2009年10月至2012年12月收治的剖宮產(chǎn)術后具有出血高危因素的孕婦161例，選取病例標準為因雙胎妊娠、巨大胎兒、羊水過多、前置胎盤等為手術指征病例。排除標準：凝血功能障礙和對前列腺素（PG）有禁忌等病例。全……