马来酸麦角新碱联合缩宫素治...防剖宫产术后出血的临床价值_冯娟宁.pdf

临床医学研究与实践2023 年 3 月第 8 卷第 9 期Clinical value of ergometrine maleate combined with oxytocin in the treatmentand prevention of hemorrhage after cesarean sectionFENG Juanning1,YANG Sha1*,JIANG Xiaoying2(1.Qishan County Hospital,Baoji 722400;2.Baoji Maternal and Child Health Hospital,Baoji 721000,China)ABSTRACT:Objective To explore the clinical value of ergometrine maleate combined with oxytocin in the treatment andprevention of hemorrhage after cesarean section.Methods A total of 74 cesarean section women admitted in our hospitalfrom January 2017 to December 2020 were selected as the research objects and randomly divided into control group andobservation group,with 37 cases in each group.The control group received oxytocin treatment,and the observation groupreceived ergometrine maleate combined with oxytocin treatment.The total blood loss at 2,4 and 24 h postpartum in the twogroups was compared;the systolic blood pressure(SBP)and diastolic blood pressure(DBP)before treatment and after 2 hof treatment and Treatment Emergent Symptom Scale(TESS)score after 3 d of treatment of the two groups were compared;the incidences of postpartum hemorrhage and postpartum anemia after 24 h of treatment in the two groups were compared;the prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(Fbg)level were compared betweenthe two groups before treatment and after 2 h of treatment.Results The total blood loss at 2,4 and 24 h postpartum in theobservation group were lower than those in the control group,and the differences were statistically significant(P0.05);after 2 h oftreatment,the SBP and DBP in the observation group were higher than those in the control group,and the differences werestatistically significant(P0.05);after 3 d of treatment,the score of TESS in the observation group was lower than that inthe control group,and the difference was statistically significant(P0.05).The incidences of postpartum hemorrhage andpostpartum anemia after 24 h of treatment in the observation group were lower than those in the control group,and thedifferences were statistically significant(P0.05);after 2 h of treatment,the PT and APTT in the observation group were shorterthan those in the control group,the Fbg level was higher than that in the control group,and the differences were statisticallysignificant(P0.05).Conclusion The ergometrine maleate combined with oxytocin in the treatment and prevention ofhemorrhage after cesarean section has a significant effect,it can improve the blood pressure level,reduce the incidences ofpostpartum hemorrhage and postpartum anemia,and has high drug safety and positive effect on improving the prognosis ofpatients,which is worth promoting in clinic.马来酸麦角新碱联合缩宫素治疗和预防剖宫产术后出血的临床价值冯娟宁1，杨莎1*，蒋晓颖2（1.岐山县医院，陕西 宝鸡，722400；2.宝鸡市妇幼保健院，陕西 宝鸡，721000）摘要：目的 探讨马来酸麦角新碱联合缩宫素治疗和预防剖宫产术后出血的临床价值。方法 选取 2017 年 1 月至 2020 年12 月我院收诊的 74 例剖宫产产妇为研究对象，遵循随机原则将其分为对照组和观察组，每组 37 例。对照组接受缩宫素治疗，观察组接受马来酸麦角新碱联合缩宫素治疗。比较两组产后 2、4、24 h 的总出血量；比较两组治疗前、治疗 2 h后的收缩压（SBP）、舒张压（DBP）及治疗 3 d 后的治疗副反应量表（TESS）评分；比较两组治疗 24 h 后的产后出血、产后贫血发生率；比较两组治疗前、治疗 2 h 后的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fbg）水平。结果 观察组产后 2、4、24 h 的总出血量均少于对照组，差异具有统计学意义（P0.05）。治疗前，两组的 SBP、DBP比较，差异无统计学意义（P0.05）；治疗 2 h 后，观察组的 SBP、DBP 均高于对照组，差异具有统计学意义（P0.05）；治疗 3 d 后，观察组的 TESS 评分低于对照组，差异具有统计学意义（P0.05）。观察组治疗 24 h 后的产后出血、产后贫血发生率均低于对照组，差异具有统计学意义（P0.05）。治疗前，两组的 PT、APTT、Fbg 水平比较，差异无统计学意义（P0.05）；治疗 2 h 后，观察组的 PT、APTT 短于对照组，Fbg 水平高于对照组，差异具有统计学意义（P0.05）。结论 马来酸麦角新碱联合缩宫素治疗和预防剖宫产术后出血的效果显著，能够改善血压水平，降低产后出血、贫血发生率，且用药安全性高，对患者预后改善有积极作用，值得临床推广。关键词：马来酸麦角新碱；缩宫素；剖宫产；产后出血；产后贫血中图分类号：R714.7文献标志码：A文章编号：2096-1413(2023)09-0115-04DOI:10.19347/ki.2096-1413.202309033作者简介：冯娟宁（1984），女，主治医师，学士。研究方向：妇产科相关。*通讯作者：杨莎，E-mail:.优生优育115-临床医学研究与实践2023 年 3 月第 8 卷第 9 期表 1两组产妇产后 2、4、24 h 的总出血量比较（x?s，mL）组别例数产后 2 h产后 4 h产后 24 h对照组37649.6341.26748.1548.77868.1639.56观察组37458.1735.24498.5737.14514.1725.23t21.46324.76545.891P0.0000.0000.000在临床中，剖宫产产后出血指剖宫产胎儿娩出后 24 h内产妇出血量1 000 mL 的疾病类型1。该病病情凶险，需要积极开展预防性治疗，以降低严重贫血、失血性休克、多脏器功能衰竭、子宫切除等病症或不良事件的发生率，若不及时治疗将会对患者带来严重影响，甚至危及生命安全2。针对剖宫产产妇，临床可采用静脉点滴缩宫素方案预防和治疗产后出血，缩宫素适用于引产、催产、产后及流产后因宫缩无力或缩复不良而引起的子宫出血3，但仍有部分产妇产后出血量大，产后出血发生率高4。随着妇产科医生对剖宫产分娩、产后出血认识的深入，马来酸麦角新碱在产科得到了一定的应用5。马来酸麦角新碱也是一种子宫收缩药，用于预防和治疗产后出血，可联合缩宫素注射液应用。因此，我院抽取 2017 年 1 月至 2020 年 12 月收诊的74 例剖宫产产妇开展本次研究，探讨马来酸麦角新碱联合缩宫素治疗和预防剖宫产术后出血的临床价值，现将具体内容报道如下。1 资料与方法1.1 一般资料选取 2017 年 1 月至 2020 年 12 月我院收诊的 74 例剖宫产产妇为研究对象，遵循随机原则将其分为对照组和观察组，每组 37 例。对照组年龄 2241 岁，平均（31.214.12）岁；孕周 3841 周，平均（40.110.58）周；体重 6185 kg，平均（73.178.15）kg；初产妇 17 例，经产妇 20 例；生产次数13 次，平均（2.120.33）次。观察组年龄 2140 岁，平均（31.184.09）岁；孕周 3841 周，平均（40.070.62）周；体重 6387 kg，平均（73.228.24）kg；初产妇 18 例，经产妇19 例；生产次数 13 次，平均（2.090.38）次。两组的一般资料无显著差异（P0.05）。本研究经我院伦理委员会批准；产妇均签署知情同意书。1.2 纳入及排除标准纳入标准：我院收治病例，自愿行剖宫产分娩；宫内单胎妊娠；对缩宫素、马来酸麦角新碱注射液不过敏；无交流沟通障碍6。排除标准：产检资料不全；并发心、肺系统等严重疾病；重要器官严重衰竭；合并精神疾病；患有凝血系统疾病、传染性疾病。1.3 方法对照组接受缩宫素治疗。分娩后，第一时间在产妇宫体位置单次肌肉注射缩宫素注射液（厂家：上海上药第一生化药业有限公司；批准文号：国药准字 H31020862），后取本品 1020 U 混合于浓度为 5%的葡萄糖溶液 500 mL中进行静脉滴注。观察组接受马来酸麦角新碱联合缩宫素治疗。静脉滴注缩宫素方法同对照组。分娩后，第一时间在产妇宫体位置单次肌肉注射马来酸麦角新碱注射液（厂家：山东新华制药股份有