張鳳華 王迎迎 劉濤

【摘要】?目的?探討卡孕栓聯(lián)合縮宮素防治瘢痕子宮二次剖宮產(chǎn)產(chǎn)后出血的臨床效果及對患者凝血功能的影響。方法?選取2017年1月至12月接受剖宮產(chǎn)手術(shù)的瘢痕子宮產(chǎn)婦200例，根據(jù)隨機(jī)數(shù)字表分為觀察組和對照組各100例，對照組術(shù)中胎兒娩出后立即予縮宮素20 U宮體肌注、20 U加入500 mL 5%的葡萄糖溶液中靜脈滴注，術(shù)后20 U加入500 mL生理鹽水中靜脈滴注，連續(xù)治療3 d;觀察組在對照組治療基礎(chǔ)上加用卡孕栓前列醇治療，即術(shù)中胎兒娩出前2分鐘給予1 mg舌下含化，術(shù)后予卡孕栓1 mg納肛，每日1次，連續(xù)治療3 d。對比觀察兩組產(chǎn)后出血量、出血率及紅蛋白（Hb）、凝血酶原時間（PT）、活化部分凝血活酶時間（APPT）、纖維蛋白原（Fib）、D-二聚體（D-D）等指標(biāo)。結(jié)果?剖宮產(chǎn)術(shù)中、術(shù)后2 h、術(shù)后24 h內(nèi)觀察組的出血量均低于對照組，比較差異有統(tǒng)計學(xué)意義（P<0.05）。觀察組產(chǎn)婦發(fā)生產(chǎn)后出血2例，發(fā)生率為2%，對照組產(chǎn)婦發(fā)生產(chǎn)后出血9例，發(fā)生率為9%，兩組比較差異有統(tǒng)計學(xué)意義（χ2=4.714，P=0.030），觀察組發(fā)生率低于對照組。術(shù)前，兩組產(chǎn)婦的Hb、PT、APTT、Fib、D-D測定值比較差異均無統(tǒng)計學(xué)意義（P>0.05）;術(shù)后72 h，觀察組的Hb、Fib、D-D測定值均高于對照組，PT、APTT測定值低于對照組，比較差異有統(tǒng)計學(xué)意義（P<0.01）。觀察組的不良反應(yīng)發(fā)生率低于對照組，但比較差異無統(tǒng)計學(xué)意義（P>0.05）。

結(jié)論?卡孕栓+縮宮素防治瘢痕子宮二次剖宮產(chǎn)產(chǎn)后出血效果較好，能夠改善患者的凝血功能。

【關(guān)鍵詞】?卡孕栓;瘢痕子宮;剖宮產(chǎn);產(chǎn)后出血;凝血功能

中圖分類號：R719.8?文獻(xiàn)標(biāo)志碼：A?DOI：10.3969/j.issn.1003-1383.2019.03.009

【Abstract】?Objective?To investigate the clinical effect of carboprost suppository combined with oxytocin on the prevention and treatment of postpartum hemorrhage after secondary cesarean section of scar uterus and its influence on coagulation function of patients.Methods?200 patients with scarred uterus who underwent cesarean section from January to December 2017 were selected and divided into observation group and control group according to random number table，with 100 cases in each group.The control group were given intrauterine injection of oxytocin 20 U immediately after delivery，20 U was injected intravenously into 500 ml 5% glucose solution，and 20 U was injected intravenously into 500 mL saline after operation for continuous 3 days.On the basis of the treatment of the control group，the observation group were given 1 mg of sublingual carboprost suppository prostol 2 minutes before delivery，and 1 mg of carboprost suppository were put into the anus of the patients after operation once a day for continuous 3 days.In addition，indexes included postpartum hemorrhage volume，hemoglobin（Hb），prothrombin time（PT），activated partial thromboplastin time（APTT），fibrinogen（Fib） and D-dimer（D-D） were compared between the two groups.Results?During cesarean section，2 hours and 24 hours after operation，bleeding volume in the observation group was lower than that in the control group，difference was statistically significant（P<0.05）.The incidence of postpartum hemorrhage was 2%（2 cases） in the observation group and 9%（9 cases） in the control group，difference was statistically significant between the two groups（χ2=4.714，P=0.030），and the incidence of postpartum hemorrhage in the observation group was lower than that in the control group.Before operation，there was no statistically significant difference in the estimated values of Hb，PT，APTT，F(xiàn)ib and D-D between the two groups（P>0.05）.72 hours after operation，the estimated values of Hb，F(xiàn)ib and D-D in the observation group were higher than those in the control group，while the estimated values of PT and APTT were lower than those in the control group，difference was statistically significant（P<0.01）.The incidence of adverse reactions in the observation group was lower than that in the control group，but difference was not statistically significant（P>0.05）.Conclusion?Carboprost suppository+oxytocin has good effect in preventing and treating postpartum hemorrhage after second cesarean section of scar uterus，and can improve the blood coagulation function of patients.