如何规范产后出血的药物治疗

产后出血（postpartum hemorrhage）是导致孕产妇死亡的首要原因。引起产后出血的原因分别为子宫收缩乏力、胎盘因素、软产道裂伤及凝血功能障碍。产后出血的病因治疗是最根本的治疗，是产后出血救治成功的关键。产后出血的药物治疗主要是针对子宫收缩乏力宫缩剂的治疗。缩宫素为一线用药，当单独手法按摩子宫和缩宫素不能达到止血目的时，可以考虑使用卡贝缩宫素、卡前列素氨丁三醇或卡前列酸栓。在没有注射用宫缩剂或注射用宫缩剂使用禁忌时可以考虑使用米索前列醇。当药物加强宫缩治疗无效时应注意不同药物的起效时间及持续时间。此外，一方面要重新核对有无合并其他原因所致产后出血；另一方面应及时采用必要的进一步治疗如宫腔填塞或子宫动脉栓塞等。

Medication of postpartum hemorrhage

Abstract:Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. The four Ts of PPH are Tone, Trauma, Tissue and Thrombin. Etiological treatment is the essential treatment. Uterotonic therapy is the most important medication of postpartum hemorrhage. The successful management of uterine atony will depend on the proper usage of the tocolytic agents, such as oxytocin, carboprost and misoprostol. Uterine packing and uterine artery embolism might be useful if the usage of tocolytic agents is not effective.