葡萄糖酸钙联合卡前列素氨丁三醇对子痫前期产妇剖宫产后出血的临床疗效研究

目的：探讨葡萄糖酸钙联合卡前列素氨丁三醇对子痫前期产妇剖宫产后出血的临床疗效。方法：选取2016年9月-2017年9月我院产科收治的160例子痫前期以剖宫产终止妊娠的产妇为研究对象,按照随机数字表法分为研究组和对照组,各80例。在胎儿娩出后,对照组给予缩宫素和卡前列素氨丁三醇,研究组在对照组的基础上加用葡萄糖酸钙。比较2组产妇手术过程中、手术结束后2 h和手术结束后24 h的出血量、产后出血率、剖宫产前后血清Ca2＋浓度和血红蛋白含量,以及用药后不良反应发生率。结果：2组产妇手术过程中的出血量比较差异无统计学意义（P＞0.05）;手术结束后2 h和24 h,研究组的出血量均少于对照组,差异有统计学意义（均P＜0.05）。研究组产后出血率为15.00%（12/80）,对照组产后出血率为36.25%（29/80）,差异有统计学意义（χ2=9.477,P=0.002）。剖宫产后,2组产妇血清Ca2＋浓度均比剖宫产前升高（均P＜0.05）,血红蛋白含量均比剖宫产前降低（均P＜0.05）。用药后不良反应发生率研究组（16.25%）和对照组（13.75%）比较差异无统计学意义（χ2=0.196,P=0.658）。结论：葡萄糖酸钙联合卡前列素氨丁三醇用于预防子痫前期产妇剖宫产的产后出血具有更好的止血效果且安全,值得临床推广。     

Impact of topical nonsteroidal anti-inflammatory drugs in prevention of macular edema following cataract surgery in diabetic patients

AIM: To evaluate the efficacy of prophylactic administration of topical non-steroidal anti-inflammatory drugs (NSAIDs) on macular edema following cataract surgery in diabetic patients, and to compare between types of NSAIDs (ketorolac tromethamine 0.4% and nepafenac 0.1%). METHODS: Group 1 (control) received artificial tears substitute as a placebo group, group 2 (nepafenac) received topical nepafenac 0.1%, and group 3 (ketorolac) received topical ketorolac tromethamine 0.4%. Patients were examined postoperatively after completing one week, one month, two months and three months'' intervals for evaluating cystoid macular edema (CME) development. The main study outcomes were achieving the best corrected visual acuity (BCVA) and change in the central macular thickness (CMT) measured with optical coherence topography (OCT). RESULTS: Eighty eyes of 76 patients were included in this study. BCVA showed a statistically significant difference at the third month postoperative follow up between the control group and the NSAIDs groups (P=0.04). There was an increase in the CMT in all cases starting from postoperative first week until third month. CMT showed a statistically significant difference between control group and NSAIDs groups from postoperative first month until third month (P=0.008, 0.027, 0.004). There was no statistically significant difference between nepafenac and ketorolac groups in BCVA and OCT CMT. CONCLUSION: Prophylactic preoperative and postoperative NSAIDs may have a role in reducing the frequency and severity of CME in diabetic eyes following cataract surgery.     

Prostaglandin E2 Levels of Aqueous and Vitreous Humor in Ketorolac 0.4% and Nepafenac 0.1% Administered Healthy Rabbits

Purpose: To compare the lowering effects of ketorolac 0.4% and nepafenac 0.1% on aqueous and vitreous humor prostaglandin E₂ (PGE₂) levels in rabbits.

Methods: Ketorolac and nepafenac ophthalmic solutions were administered to the right eyes of 24 healthy rabbits after randomized division into two groups. The left eyes of these rabbits were considered as controls for the two groups. On the 4th day of the experiment, the samples were taken from the aqueous and vitreous humors of the rabbits bilaterally, and PGE₂ levels were measured by an enzyme immune assay kit.

Results: Ketorolac and nepafenac achieved a statistically significant decrease (p<0.001, for each) in PGE₂ levels in the aqueous (11.75 ± 6.15 and 14.75 ± 7.60 pg/mL, respectively) and the vitreous humor (6.58 ± 4.62 and 9.83 ± 4.55 pg/mL, respectively).

Conclusions: Both ketorolac and nepafenac inhibited PGE₂ levels in both the aqueous and vitreous humors of rabbits. Although PGE₂-lowering effects were similar in the aqueous humor, nepafenac seemed to be more potent than ketorolac in the vitreous humor.     

Efficacy of carboprost tromethamine combined with leonurus japonicus for prevention of postpartum hemorrhage in high-risk pregnant women: A protocol for systematic review and meta-analysis

Background:No well-designed and systematic evaluation of the efficacy and safety of leonurus japonicus injection (LJI) in combination with carboprost tromethamine has been found. Therefore, we undertook a meta-analysis to assess the efficacy and safety of carboprost tromethamine combined with LJI for the prevention of postpartum hemorrhage in high-risk pregnant women to provide new evidence-based medical evidence for clinical treatment.Methods:This systematic review and meta-analysis would be performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The following databases including EMBASE, MEDICINE, Wanfang, China National Knowledge Infrastructure database, and Cochrane central controlled trial registries were searched by 2 reviewers from inception to July 2021. Mesh and keyword search terms were “motherwort,” “Yimucao,” “leonurus japonicas,” “carboprost tromethamine,” and “postpartum hemorrhage.” Any cohort studies that assessed the efficacy and safety of carboprost tromethamine combined with LJI for the prevention of postpartum hemorrhage would be included. P < .05 was set as the level of significance.Results:The review would add to the existing literature by showing compelling evidence and improved guidance in clinic settings.OSF registration number:10.17605/OSF.IO/2WC53.     

酮咯酸氨丁三醇超前镇痛对扁桃体切除术患者血流动力学的影响

目的观察酮咯酸氨丁三醇超前镇痛对扁桃体切除术患者气管拔管期血流动力学的影响及术后的镇痛效果。方法选择择期行双侧扁桃体切除术的全麻患者60例,随机分为2组:观察组(酮咯酸氨丁三醇30 mg),对照组(生理盐水)。手术开始前15 min,观察组静注酮咯酸氨丁三醇30 mg,对照组静注等剂量生理盐水。记录两组患者的一般资料,入室、拔管即刻、拔管后5 min、拔管后10 min患者的收缩压、舒张压、心率、血氧饱和度,苏醒期躁动评分,拔管后5 min、10 min、1 h时的OAA/S评分和拔管后1、4、6、12 h的VAS评分,记录患者的手术时间、麻醉时间、拔管时间及术后不良反应。结果拔管即刻及拔管后5、10 min,观察组的SBP为(124.9±7.7)、(120.3±9.2)、(118.9±9.3)mm Hg,DBP为(73.8±5.9)、(71.8±8.1)、(69.5±8.0)mm Hg;对照组的SBP为(138.0±9.4)、(134.9±11.0)、(132.7±10.8)mm Hg,DBP为(82.3±8.5)、(80.6±9.6)、(79.8±8.5)mm Hg,观察组各时点的血压均低于对照组,差异有统计学意义(P<0.05)。拔管后1、4、6、12 h,观察组的VAS评分为1.0±0.8、1.4±0.7、2.2±1.0、2.8±0.6,对照组为2.7±1.0、3.5±1.1、4.1±1.0、3.2±1.1,观察组评分低于对照组(P<0.05)。结论酮咯酸氨丁三醇30 mg超前镇痛用于成人双侧扁桃体切除术患者气管拔管期血流动力学波动小,镇痛效果良好。     

卡前列素氨丁三醇联合宫腔纱条填塞治疗宫缩乏力性产后出血效果观察

【摘要】 目的 探析剖宫产后再次妊娠剖宫产子宫收缩乏力应用卡前列素氨丁三醇联合宫腔纱条填塞治疗产后出血的临床效果。方法 选择2015年1月~2017年1月期间收治的剖宫产后再次妊娠剖宫产术中子宫收缩乏力患者70例为研究对象,随机分为两组,其中给予对照组常规止血治疗,而观察组则应用卡前列素氨丁三醇和宫腔纱条填塞联合治疗,对两组的治疗效果进行对比分析。结果 与对照组比较,观察组产后2h和24h出血量均较少,组间比较差异显著（P＜005）;观察组的术后并发症发生率较低,但是组间比较无明显差异（P＞005）;同时,两组的住院时间、血红蛋白含量比较差异有统计学意义（P＜005）。结论 卡前列素氨丁三醇联合宫腔纱条填塞治疗剖宫产后再次妊娠剖宫产子宫收缩乏力性产后出血,具有起效快、效果确切及不良反应少等优点,可安全地用于临床。     

产后出血的治疗

产后出血（postpartum hemorrhage）是我国孕产妇死亡的首要原因,导致产后出血的主要因素有子宫收缩乏力、软产道裂伤、胎盘因素、贫血和凝血功能障碍等。近年来,由于我国生育政策的调整,孕产妇平均年龄逐渐升高,产后出血的发病率和严重程度也呈增长趋势,医疗机构应结合产妇实际情况识别产后出血,注重对产后出血原因的分析和研究,并及时进行预防和采取有效的应对措施,制定个体化治疗策略,保持母体血流动力学稳定,促进子宫收缩,实施适当的外科手术以及恰当的血液制品输注,必要时使用氨甲环酸、重组人活化因子Ⅶ和纤维蛋白原等药物,改善止血,使患者得到及时有效的治疗,降低出血相关死亡率,提高患者生活质量。     

卡前列素氨丁三醇预防前置胎盘剖宫产产后出血临床研究

目的观察卡前列素氨丁三醇（欣母沛）预防前置胎盘剖宫产产后出血的临床疗效。方法该院从2006年1月～2007年10月因前置胎盘剖宫产62例,其中1例被排除,31例对照组子宫体部注射缩宫素20u及口服米索前列醇400μg,30例治疗组子宫体注射卡前列素氨丁三醇（欣母沛）250μg,两组均予以静脉滴注20u缩宫素。结果治疗组比对照组第3产程时间缩短,产后2h及产后24h平均出血量减少,治疗组产后出血发生率明显少于对照组。结论卡前列素氨丁三醇（欣母沛）预防治疗前置胎盘引起的宫缩乏力性产后出血效果显著。