魏伟 庞恩翠 张俊红 刘洁

【摘要】 目的：探討改良Hayman缝合术联合卡前列素氨丁三醇治疗剖宫产产后出血及对卵巢恢复的应用效果。方法：选取2019年10月—2022年11月对菏泽市牡丹人民医院剖宫产产后出血患者86例，按随机数字表法分为两组，对照组43例行8字法缝合联合卡前列素氨丁三醇治疗，观察组43例实施改良Hayman缝合术联合卡前列素氨丁三醇治疗，比较两组手术相关指标、疗效、卵巢功能指标、并发症发生情况。结果：观察组住院时间短于对照组，月经复潮时间早于对照组，术中、术后2 h和术后24 h出血量均少于对照组，差异均有统计学意义（P<0.05）；观察组治疗总有效率高于对照组，差异有统计学意义（P<0.05）；术后，观察组抗米勒管激素（AMH）、雌二醇（E2）均高于对照组，促黄体生成素（LH）、促卵泡生成素（FSH）均低于对照组，差异均有统计学意义（P<0.05）；观察组并发症总发生率低于对照组，差异有统计学意义（P<0.05）。结论：将改良Hayman缝合术联合卡前列素氨丁三醇应用到剖宫产产后出血治疗中，可有效提高手术效率，降低术中及术后出血量，改善卵巢功能，且并发症发生率低。

【关键词】 剖宫产 产后出血 改良Hayman缝合术 卡前列素氨丁三醇 卵巢恢复

Effectiveness of Modified Hayman Suturing Combined with Carboprost Tromethamine in the Treatment of Postpartum Hemorrhage and Ovarian Recovery after Cesarean Section/WEI Wei， PANG Encui， ZHANG Junhong， LIU Jie. //Medical Innovation of China， 2024， 21（08）： 0-029

[Abstract] Objective： To explore the application effect of modified Hayman suture combined with Carboprost Tromethamine in treating postpartum hemorrhage and facilitating ovarian recovery after cesarean section. Method： A total of 86 patients with postpartum hemorrhage after cesarean section from October 2019 to November 2022 were selected and divided into two groups according to random number table method. The control group （43 patients） received 8-character suture combined with Carboprost Tromethamine， while the observation group （43 patients） underwent modified Hayman suturing combined with Carboprost Tromethamine treatment. The surgical indicators， therapeutic effects， ovarian function， and complications between the two groups were compared. Result： The hospitalization time of the observation group was shorter than that of the control group， menstrual recovery time of the observation group was earlier than that of the control group， and the amount of bleeding during operation， 2 h after operation and 24 h after operation were lower than those of the control group， the differences were statistically significant （P<0.05）. The total effective rate of the observation group was higher than that of the control group， the difference was statistically significant （P<0.05）. After operation， levels of anti-Müllerian hormone （AMH）， and estradiol （E2） were significantly higher in the observation group compared to the control group， levels of luteinizing hormone （LH）， follicle-stimulating hormone （FSH） were significantly lower in the observation group compared to the control group （P<0.05）. The incidence of complications in the observation group was significantly lower than that in the control group （P<0.05）. Conclusion： The application of modified Hayman suturing combined with Carboprost Tromethamine in the treatment of postpartum hemorrhage after cesarean section can effectively improve surgical efficiency， reduce intraoperative and postoperative blood loss， improve ovarian function， and lower the incidence of complications.

[Key words] Cesarean section Postpartum hemorrhage Modified Hayman suturing Carboprost Tromethamine Ovarian recovery

First-author's address： Obstetrics and Gynecology Staff Room， Heze Medical College， Heze 274000， China

doi：10.3969/j.issn.1674-4985.2024.08.006

剖宮产产后出血是临床上较为常见的并发症，严重者可能导致母体失血性休克，甚至死亡，对女性健康构成了严重威胁[1]。产后出血的发生通常与子宫收缩乏力、残留胎盘组织、凝血功能障碍等多种因素相关[2]。产后出血的治疗主要依赖于宫腔填塞、药物和缝合术等方式，但仅靠药物治疗在严重产后出血案例中可能效果不佳，传统的缝合手段可能带来更大的创伤和并发症风险[3]。改良Hayman缝合术是一种基于B-Lynch的改良术式，通过特定的缝合技巧实现对子宫的压迫，从而促进血管收缩，有效控制出血，同时尽量减少对子宫的损伤[4]。卡前列素氨丁三醇作为一种子宫收缩剂，通过促进子宫平滑肌的收缩，帮助控制出血，在产后出血治疗中的应用效果受到广泛认可[5]。……