董春燕 张继红

摘 要 目的：探討前置胎盘产妇剖宫产术中出血使用卡前列素氨丁三醇治疗的效果。方法：收集2018年11月至2020年2月江西省新余市妇幼保健院收治的前置胎盘产妇剖宫产术中出血患者52例，按照抽签法分为观察组和对照组各26例。两组均给予常规预防感染、压迫子宫止血、局部缝合胎盘剥离面等基础治疗。对照组注射20 U缩宫素。观察组在对照组基础上，肌肉注射卡前列素氨丁三醇250 mg，1次/d。两组均治疗1 d。观察出血、止血情况、凝血功能、血流动力学和不良反应。结果：观察组产后2 h、24 h出血量少于对照组（P<0.05），观察组止血时间早于对照组（P<0.05）；观察组凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）均短于治疗前以及对照组，纤维蛋白原（FIB）值低于治疗前和对照组（P<0.05），D-二聚体（D-D）值则高于治疗前以及对照组（P<0.05）；观察组治疗后心率（HR）高于治疗前和对照组（P<0.05），收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）均低于治疗前和对照组（P<0.05）；两组不良反应的差异无统计学意义（P>0.05）。结论：前置胎盘产妇剖宫产术中出血使用卡前列素氨丁三醇治疗效果明显，可以改善产后2 h、24 h出血量，缩短止血时间，改善凝血功能和血流动力学，且不增加产妇不良反应。

关键词 前置胎盘；剖宫产；术中出血；卡前列素氨丁三醇

中图分类号：R719.8 文献标志码：A 文章编号：1006-1533（2021）10-0018-04

Effect of carboprost tromethamine in the treatment of hemorrhage during cesarean section in women with placenta previa

DONG Chunyan， ZHANG Jihong

（Second Obstetrics Department of Maternal and Child Health Care Hospital of Xinyu， Jiangxi 338000， China）

ABSTRACT Objective： To explore the effect of carboprost tromethamine in the treatment of hemorrhage during cesarean section in women with placenta previa. Methods： From November 2018 to February 2020， 52 cases of hemorrhage during cesarean section of maternal placenta previa admitted to the Maternal and Child Health Hospital of Xinyu City， Jiangxi Province were collected， and according to the drawing method， divided into an observation group and a control group with 26 cases in each group. Both groups were given basic treatments such as routine prevention of infection， compression of the uterus to stop bleeding， and partial suture of the placenta peeling surface. The control group was injected with 20 U oxytocin. On the basis of the control group， the observation group was given carboprost tromethamine 250 μg intramuscularly， once a day. Both groups were treated for 1 d. The bleeding， hemostasis， coagulation function， hemodynamics and adverse reactions were observed. Results： The amount of bleeding at 2 h and 24 h after delivery in the observation group was less than that in the control group（P<0.05）， and the hemostasis time in the observation group was earlier than that in the control group （P<0.05）； the thromboplastin time（APTT）， prothrombin time（PT）， and thrombin time（TT） in the observation group were shorter than those before treatment and in the control group， fibrinogen（FIB） value in the observation group was lower than that before treatment and in the control group （P<0.05）， D-Dimer（D-D） value was higher in the observation group than that before treatment and in the control group（P<0.05）； the heart rate（HR） in the observation group after treatment was higher than that before treatment and in the control group （P<0.05）， and the systolic blood pressure（SBP）， diastolic blood pressure（DBP） and mean arterial pressure（MAP） were lower than those before treatment and in the control group（P<0.05）； there was no significant difference in adverse reactions between the two groups（P>0.05）. Conclusion： Carboprost tromethamine is effective in the treatment of hemorrhage during cesarean section in women with placenta previa， which can improve the bleeding volume at 2 h and 24 h after delivery， shorten the time of hemostasis， and improve coagulation function and hemodynamic level without increasing adverse maternal reactions.

KEY WORDS placenta previa； cesarean section； intraoperative hemorrhage； carboprost tromethamine

孕婦在妊娠28周后，胎盘附着于子宫下段，胎盘下缘甚至达到或覆盖宫颈内口，其位置低于胎先露部，即为前置胎盘。前置胎盘是造成孕妇妊娠晚期出血的主要原因之一，剖宫产是终止前置胎盘妊娠的首选方式。然而，术中、术后出血等并发症的发生，增加了手术风险[1-2]。缩宫素可促进子宫平滑肌收缩，降低人体内肾上腺酮等压力激素水平，从而降低血压，但因受个体影响，其治疗效果存在差异[3-5]。肌内注射卡前列素氨丁三醇，能够刺激子宫收缩，降低产后出血的发生[6-7]。本院从多个角度分析卡前列素氨丁三醇治疗前置胎盘产妇剖宫产术中出血的效果。……