目的 观察卡前列素氨丁三醇与麦角新碱预防剖宫产产妇出血及对子宫复旧的作用.方法 该项目为回顾性研究,选取2019年3月至2024年1月在合肥市第一人民医院行剖宫产术的产妇118例,根据产后药物干预方案分为A组(n=48,采用麦角新碱治疗)、B组(n=33,采用卡前列素氨丁三醇治疗)和C组(n=37,采用卡前列素氨丁三醇联合麦角新碱治疗).收集3组患者临床资料,比较3组患者产后出血量、恶露持续时间、住院时间、产后出血发生率及子宫复旧情况,评估3组产妇药品不良反应.结果 A组和B组产后2 h及24 h出血量、恶露持续时间和住院时间分别为[A:(343.58±49.32)mL,(426.35±68.65)mL,(18.25±3.21)d,(5.26±0.25)d;B:(341.63±54.27)mL,(431.25±63.59)mL,(17.98±2.66)d,(5.34±0.32)d]比较,差异无统计学意义(t=0.168,0.325,0.398,1.261,P=0.867,0.746,0.692,0.211)(P>0.05);C组产后2 h及24 h出血量,恶露持续时间和住院时间分别为(215.65±42.36)mL,(301.36±50.35)mL,(14.21±2.14)d,(4.21±0.43)d,均少于A组和B组(C vs A:t=16.968,13.030,9.465,20.289,均P<0.001;C vs B:t=15.267,12.372,8.070,19.950,均P<0.001).3组产后出血发生率分别为4.17%,30.3%,0,差异无统计学意义(P=0.624).A组和B组产后3 d、5 d的子宫下降程度分别为[A:(2.09±0.18)cm,(4.03±0.25)cm;B:(2.16±0.39)cm,(4.15±0.34)cm],均差异无统计学意义(t=1.088,1.831,P=0.280,0.071),C组以上指标分别为(2.94±0.23)cm,(4.89±0.29)cm,均大于A组和B组(C vs A:t=20.460,17.154,均P<0.001;C vs B:t=19.177,15.077,均P<0.001).A,B,C 组患者总不良反应发生率分别为14.58%,9.09%,24.32%,差异无统计学意义(χ2=3.134,P=0.209).结论 卡前列素氨丁三醇与麦角新碱均可有效促进子宫收缩,预防产后出血,促进子宫复旧,两者联合可能具有协同作用,可更进一步的提高临床效果.
Preventive effect of carboprost tromethamine and ergometrine on postpartum hemorrhage and their influence on uterine involution in puerperae undergoing cesarean section
Objective To observe the preventive effect of carboprost tromethamine and ergometrine on postpartum hemorrhage and their influence on uterine involution in puerperae undergoing cesarean section.Methods The clinical data of 118 patients undergoing cesarean section in Hefei First People's Hospital from March 2019 to January 2024 were retrospectively analyzed.According to different postpartum intervention methods,they were divided into group A(n=48,ergometrine),group B(n=33,carboprost tromethamine)and group C(n=37,carboprost tromethamine+ergometrine).The postpartum blood loss,lochia duration,hospitalization time,incidence of postpartum hemorrhage and uterine involution were compared among the three groups.The adverse medication reactions in the three groups were also evaluated.Results There was no significant difference in blood loss at 2 h and 24 h after delivery,lochia duration or hospitalization time between group A and group B[(343.58±49.32)mL,(426.35±68.65)mL,(18.25±3.21)d,(5.26±0.25)d vs(341.63±54.27)mL,(431.25±63.59)mL,(17.98±2.66)d,(5.34±0.32)d],the difference was not statistically significant(t=0.168,0.325,0.398,1.261,P=0.867,0.746,0.692,0.211).The blood loss at 2 h and 24 h after delivery,lochia duration and hospitalization time in group C were(215.65±42.36)mL,(301.36±50.35)mL,(14.21±2.14)d and(4.21±0.43)d,respectively.They were lower than those in group A and B(C vs A:t=16.968,13.030,9.465,20.289,P<0.001;C vs B:t=15.267,12.372,8.070,19.950,P<0.001).The incidence of postpartum hemorrhage in the three groups was 4.17%,30.3%and 0,the difference was not statistically significant among the three groups(P=0.624).On day 3 and 5 after delivery,there was no significant difference in uterine decline degree between group A and group B[(2.09±0.18)cm,(4.03±0.25)cm vs(2.16±0.39)cm,(4.15±0.34)cm],the difference was not statistically significant(t=1.088,1.831,P=0.280,0.071).However,it was(2.94±0.23)cm and(4.89±0.29)cm in group C,significantly higher than that in group A and B(C vs A:t=20.460,17.154,P<0.001;C vs B:t=19.177,15.077,P<0.001).The total incidence of adverse reactions in the group A,B and C was 14.58%,9.09%and 24.32%,and the difference was not statistically significant among the three groups(χ2=3.134,P=0.209).Conclusion Both carboprost tromethamine and ergometrine can effectively promote uterine contraction,prevent postpartum hemorrhage and promote uterine involution.The combined application of these two drugs may have synergistic effect,which can further improve clinical effect.
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