董宝剑 胡强夫 闵娜

摘 要 目的：评估卡前列素氨丁三醇联合改良B-Lynch缝合术治疗二次剖宫产后出血的效果。方法：选取二次剖宫产术后出血患者80例，随机分为对照组和观察组各40例，对照组给予宫体注射缩宫素结合宫腔填纱，观察组给予宫体注射卡前列素氨丁三醇结合改良B-Lynch缝合术。比较两组的出血量、平均手术时间、止血时间、住院时间和术后不良反应发生情况。结果：观察组在剖宫产术中、术后2 h和24 h的出血量均低于对照组；平均手术时间、止血时间和住院时间均少于对照组；术后不良反应发生率低于对照组（P<0.05）。结论：卡前列素氨丁三醇联合改良B-Lynch缝合术可减少二次剖宫产术中和术后出血量，缩短患者住院时间，且不良反应发生率低。

关键词 剖宫产 产后出血 卡前列素氨丁三醇 B-Lynch缝合术

中图分类号：R979.22； R719.8 文献标志码：B 文章编号：1006-1533（2021）09-0028-03

Effect of carboprost tromethamine combined with B-Lynch suture in the treatment of hemorrhage after cesarean section

DONG Baojian， HU Qiangfu， MIN Na

（Department of Anesthesiology， the Fifth Hospital affiliated to Zhengzhou University， Zhengzhou 450052， China）

ABSTRACT Objective： To evaluate the effect of carboprost tromethamine combined with modified B-Lynch suture in the treatment of hemorrhage after second cesarean section. Methods： Eighty patients with bleeding after the second cesarean section were selected and randomly divided into a control group and an observation group with 40 cases each. The control group was given intrauterine injection of oxytocin combined with intrauterine gauze while the observation group was given intrauterine injection of carboprost trometamol combined with modified B-Lynch suture. The bleeding volume， the times for average operation， hemostasis， hospitalization and the incidence of postoperative adverse reactions were compared between the two groups. Results： The bleeding volume at postoperative 2 and 24 hours and the times for average operation， hemostasis and hospital stay were less in the observation group than the control group during cesarean section， and the incidence of postoperative adverse reactions was lower in the observation group than that the control group （P<0.05）. Conclusion： Carboprost tromethamine combined with modified B-Lynch suture can reduce the volume of bleeding during and after the second cesarean section， shorten the patients hospital stay， and has a low incidence of adverse reactions.

KEy WORDS cesarean section； postpartum hemorrhage； carboprost tromethamine； B-Lynch suture

隨着国家二胎政策的实施，产妇的二次剖宫产率逐年递增。由于一胎剖宫产时产生瘢痕子宫，所以二次剖宫产妇出现产后出血的几率较高[1]。产后出血即剖宫产妇娩出胎儿后的24 h内阴道出血超过1 000 ml，严重时可导致产妇或胎儿死亡[2]。产后出血的主要原因有子宫收缩乏力、凝血功能障碍、软产道裂伤、胎盘因素及高危妊娠等，预防二次剖宫产后出血是非常重要的[3]。目前临床上主要采用缩宫素和子宫按摩等措施来应对产妇分娩中出现的子宫收缩乏力，临床效果一般[4]。卡前列素氨丁三醇（商品名：欣母沛），是一种强力的子宫收缩剂，可对子宫平滑肌群产生强烈收缩作用而止血，因此在临床上用于治疗难治性、子宫收缩乏力引起的产后出血[5]。本研究对卡前列素氨丁三醇联合改良B-Lynch缝合术治疗产后出血的效果进行分析，现报告如下。……