米索前列醇预防产后出血高危因素效果观察

目的观察米索前列醇应用于防治有产后出血高危因素的产妇剖宫产术中、术后出血的有效性和安全性。方法对338例有产后出血高危因素的产妇行计划性剖宫产术。术中胎儿娩出后按宫缩剂使用情况分为两组，缩宫素组160例，缩宫素20U宫体注射，10U加入液体中静滴；缩宫素＋米索前列醇组178例，缩宫素20u宫体注射，10U加入液体中静滴，米索前列醇400μg舌下含服，计算术中、术后2h及术后24h总出血量，并观察两组的副反应。结果（1）两组产妇术中出血量分别为缩宫素组（412±243）ml，缩宫素＋米索前列醇组（322±206）ml，两组比较，差异有统计学意义（P〈0.01）；（2）两组术后2h出血量分别为缩宫素组（197±173）ml，缩宫素＋米索前列醇组（111±97）ml，两组比较差异有统计学意义（P〈0.05）；（3）两组产妇24h总出血量≥1000ml的27例，其中缩宫素组19例，缩宫素＋米索前列醇组8例，无1例切除子宫。缩宫素组总出血量明显多于缩宫素＋米索前列醇组；分别为（698±319）ml及（471＋224）ml，两组比较，差异有统计学意义（P〈0.01）；（4）副反应发生率缩宫素组为1.6％，缩宫素＋米索前列醇组为8.5％，后者主要以恶心、呕吐为常见症状，短时间好转消失。结论米索前列醇＋缩宫素用于有产后出血高危因素的产妇剖宫产，可明显减少术中及术后出血量。

Clinical study on prevention of postpartum hemorrhage of cesarean section is used in high risk pregnant women

Objective To observe the effect and safety of on prevention of postpartum hemorrhage in cesarean section and after cesarean section in high risk pregnant women. Methods Three hundred and thirty - eight pregnant women with high hemorrhagic risk factors, placenta previa were planned cesarean section, two kinds of hysterotonies were used randomly in each group . Group oxytoein （O）：20U oxytocin injected into the uterine plus 10 U oxytocin intravaseularly, 160 women; Group oxgtoein ＋ misoprosto1：20 U oxytocin injected into the uterine 10 U oxytoein intravaseularly and 400μg. Results The amount of bleeding during cesarean section in group was （412±243） ml, in group O＋M（322±206）ml, there was an extremely significant difference between group O and group O＋M（P〈0.01）, the amount of bleeding within 2 hours after delivery in group O was （197±173） ml, in group O＋ M（111±97） ml, there was a significant difference between groups O and group O＋ M. among the 338 women, 27 had total amount of bleeding more than 1000 ml during operation and within 2 hours after delivery. 70.4% （19 women） were in group O ,29.6% （8 woman） in group O＋ M. The total amount of bleeding in group O was much more then group O＋ M（P〈0.01）. No hysterectomy was done among the women. Conclusion Misoprostol can significantly reduce the amount ot bleeding during the cesarean section in pregnant women with high hemorrhagic risk factors and be used with oxytocin as first line medicine to prevent hemorrhage during and after delivery.