李淑

[摘要]目的 探討缩宫素联合米索前列醇预防产后出血的临床效果。方法 选取2016年10月～2017年10月在我院产科行足月阴道分娩的120例产妇，随机分为两组，每组各60例。对照组于胎儿娩出后给予缩宫素10 U肌内注射并静脉滴注10 U，观察组在此基础上给予米索前列醇400 μg塞肛，比较两组的产后出血率、产后出血量、第三产程时间、给药前后血压及心率变化。结果 观察组产后出血率为1.67%，明显低于对照组（15.00%），产后2、24 h出血量明显少于对照组，差异有统计学意义（P<0.05）；观察组第三产程时间明显短于照组，差异有统计学意义（P<0.05）；观察组给药后收缩压、舒张压、心率与对照组比较明显降低，差异有统计学意义（P<0.05）；两组的恶心、呕吐、寒战、面部潮红、血压升高等不良反应发生率，差异无统计学意义（P>0.05）。结论 缩宫素联合米索前列醇预防产后出血的临床效果显著，能有效缩短第三产程，减少产后出血量，降低产后出血率，稳定血流动力学，且不良反应轻微，具有积极的临床意义。

[关键词]产后出血；缩宫素；米索前列醇；临床效果

[中图分类号] R714.641 [文献标识码] A [文章编号] 1674-4721（2018）7（b）-0101-03

[Abstract] Objective To investigate the clinical effect of Oxytocin combined with Misoprostol in preventing postpartum hemorrhage. Methods A total of 120 cases of term vaginal delivery in our hospital were randomly divided into two groups from October 2016 to October 2017， 60 cases in each group. The control group was given intramuscular injection of Oxytocin 10 U and intravenous drip of 10 U after delivery， the obseruation group on the basis of the control group， Misoprostol 400 μg plug anus was administered， compared the two groups with the rate of postpartum hemorrhage， the amount of postpartum hemorrhage， the time of the third stage of labor， the changes of blood pressure and heart rate before and after administration. Results The postpartum haemorrhage rate was 1.67%， significantly lower than 15.00% in the control group， significantly less than the control group with 2 h and 24 h， and the differences were statistically significant （P<0.05）. The third stage of the observation group was significantly shorter than the control group， and the difference was statistically significant （P<0.05）. In the observation group， the systolic blood pressure， diastolic blood pressure and heart rate were significantly decreased compared with the control group， and the differences were statistically significant （P<0.05）. There was no significant difference between the two groups in the incidence of nausea， vomiting， cold war， facial flushing， and elevated blood pressure （P>0.05）. Conclusion The clinical effect of Oxytocin combined with Misoprostol on the prevention of postpartum hemorrhage is remarkable. It can effectively shorten the third stage of labor， reduce the amount of postpartum hemorrhage， reduce the rate of postpartum hemorrhage， stabilize hemodynamics， and the adverse reaction is slight， which has positive clinical significance.

[Key words] Postpartum hemorrhage； Oxytocin； Misoprostol； Clinical effect

产后出血是导致临床产妇死亡的最主要原因，是指产后24 h内阴道出血量超过500 ml，若不及时采取有效措施控制，可导致产妇发生失血性休克，甚至死亡。产后出血的发生主要与子宫收缩乏力有关，如胎盘残留、胎盘植入、软产道损伤等也可引起产后出血[1]。因此，防治产后出血的关键在于增强子宫收缩力，促进子宫内血管的收缩闭合，以减少出血量，降低产后出血率。缩宫素是临床最为常用的预防产后出血药物，但疗效不一，个体差异较大，大剂量使用会达到子宫内受体饱和而无法发挥疗效。米索前列醇属于新型的口服前列素E1衍生物，对子宫的收缩力强，与缩宫素合用协同增效[2]。……