缩宫素联合前列腺素类药物预防高危妊娠且行剖宫产产后出血的临床观察

目的 探讨缩宫素联合前列腺素类药物预防高危妊娠且行剖宫产产后出血的临床疗效。方法 选取2012年1月-2013年12月延安大学附属医院产科住院的高危妊娠且行剖宫产产妇330例，按随机对照原则分为3组，卡前列素氨丁三醇联合缩宫素组、卡前列甲酯栓联合缩宫素组和缩宫素组，各110例。卡前列素氨丁三醇联合缩宫素组：胎儿娩出后立即宫体肌内注射卡前列素氨丁三醇250 μg，及静脉滴注缩宫素10 U；卡前列甲酯栓联合缩宫素组：胎儿娩出后立即舌下含化卡前列甲酯栓1 mg，及静脉滴注缩宫素10 U；缩宫素组：胎儿娩出后立即静脉滴注缩宫素10 U，以及宫体肌内注射缩宫素10 U。比较3组术中及术后2 h、2～24 h的出血量；观察3组产后出血、输血及附加止血措施情况；观察3组用药后的副反应。结果 术中、术后2 h、2～24 h，卡前列素氨丁三醇联合缩宫素组比卡前列甲酯栓联合缩宫素组、缩宫素组出血量均减少，差异有统计学意义（P〈0.05）；卡前列甲酯栓联合缩宫素组与缩宫素组术中、术后2 h相比出血量减少，差异有统计学意义（P〈0.05），而与术后2～24 h出血量相比，差异无统计学意义。卡前列素氨丁三醇联合缩宫素组与卡前列甲酯栓联合缩宫素组产后出血率、输血率及附加止血措施干预率均低于缩宫素组，差异均有统计学意义（P〈0.05）。3组的副反应率分别为9.09%、8.18%和6.36%，比较无统计学意义。结论 应用卡前列素氨丁三醇联合缩宫素可有效预防高危妊娠产后出血，卡前列甲酯栓联合缩宫素亦可达到一定的预防疗效，而单纯应用缩宫素疗效欠佳。

Clinical observation of oxytocin combined with prostaglandins in prevention of postpartum hemorrhage of high-risk pregnancy puerperae with caesarean section

Objective To investigate the clinical efficacy of oxytocin combined with prostaglandins in the prevention of postpartum hemorrhage of high-risk pregnancy puerperae with caesarean section. Methods High-risk pregnancy puerperae （330 cases） with caesarean section in Affiliated Hospital of Yan＇an University from January 2012 to December 2013 were randomly divided into 3 groups （110 cases in each group）. They were carboprost tromethamine combined with oxytocin （CTO） group, carboprost methylate combined with oxytocin （CMO） group, and oxytocin group. And patients in the CTO group were im given carboprost tromethamine 250 μg in the body of uterus following fetus expulsion, and then were iv oxytocin 10 U. The patients in the CMO group were sublingual administered with carboprost methylate 1 mg following fetus expulsion, and were iv oxytocin 10 U. The patients in the oxytocin group were iv oxytocin 10 U following fetus expulsion, and were im given oxytocin 10 U in body of uterus. The quantity of bleeding was compared among the three groups during the operation, 2, and 2 - 4 h after operation. The postpartum hemorrhage, blood transfusion, and additional hemostatic measures after delivery were observed among the three groups. The side reaction was also observed among the three groups. Results During operation, 2, and 2 - 4 h after operation, the quantity of bleeding of maternal in the CTO group was less than that in the CMO group and oxytocin group, with the significant difference （P 〈 0.05）. During the operation, 2 h after operation, the quantity of bleeding of maternal in the CMO group was significantly less than that in the oxytocin group （P 〈 0.05）. While 2 - 4 h after the operation, there was no significant difference. The postpartum hemorrhage, blood transfusion rate, and additional intervention measures to stop bleeding in the CTO and CMO groups were significantly lower than those in the oxytocin group （P 〈 0.05）. The side effects of the three groups were 9.09%, 8.18%, and 6.36%, respectively, and there was no significant difference. Conclusion CTO is effective in preventing postpartum hemorrhage of high-risk pregnancy. CMO could reach a certain preventive effect, but the application of oxytocin simply is poor efficacy.