卡孕栓联合缩宫素防治瘢痕子宫二次剖宫产术后出血的效果观察

张凤华 王迎迎 刘涛

【摘要】 目的 探讨卡孕栓联合缩宫素防治瘢痕子宫二次剖宫产产后出血的临床效果及对患者凝血功能的影响。方法 选取2017年1月至12月接受剖宫产手术的瘢痕子宫产妇200例，根据随机数字表分为观察组和对照组各100例，对照组术中胎儿娩出后立即予缩宫素20 U宫体肌注、20 U加入500 mL 5%的葡萄糖溶液中静脉滴注，术后20 U加入500 mL生理盐水中静脉滴注，连续治疗3 d;观察组在对照组治疗基础上加用卡孕栓前列醇治疗，即术中胎儿娩出前2分钟给予1 mg舌下含化，术后予卡孕栓1 mg纳肛，每日1次，连续治疗3 d。对比观察两组产后出血量、出血率及红蛋白（Hb）、凝血酶原时间（PT）、活化部分凝血活酶时间（APPT）、纤维蛋白原（Fib）、D-二聚体（D-D）等指标。结果 剖宫产术中、术后2 h、术后24 h内观察组的出血量均低于对照组，比较差异有统计学意义（P<0.05）。观察组产妇发生产后出血2例，发生率为2%，对照组产妇发生产后出血9例，发生率为9%，两组比较差异有统计学意义（χ2=4.714，P=0.030），观察组发生率低于对照组。术前，两组产妇的Hb、PT、APTT、Fib、D-D測定值比较差异均无统计学意义（P>0.05）;术后72 h，观察组的Hb、Fib、D-D测定值均高于对照组，PT、APTT测定值低于对照组，比较差异有统计学意义（P<0.01）。观察组的不良反应发生率低于对照组，但比较差异无统计学意义（P>0.05）。

结论 卡孕栓+缩宫素防治瘢痕子宫二次剖宫产产后出血效果较好，能够改善患者的凝血功能。

【关键词】 卡孕栓;瘢痕子宫;剖宫产;产后出血;凝血功能

中图分类号：R719.8 文献标志码：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，Fib and D-D between the two groups（P>0.05）.72 hours after operation，the estimated values of Hb，Fib 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.