直肠给予米索前列醇与静注缩宫素对预防产后出血的对比研究

目的 考察直肠给予（肛塞）600 μg米索前列醇与静注10 IU缩宫素对预防产后出血的效果. 方法 200例经阴道分娩的产妇随机分为2组（每组100例）,A组在胎儿娩出1min内立即直肠给予600 μg米索前列醇＋1安瓿NS溶于20 ml林格氏液（作为安慰剂对照）静注;B组接受肛塞3粒空胶囊（作为安慰剂对照）＋10 IU缩宫素溶于20ml林格氏液静注.分娩前及产后24 h均抽血检测Hb、HCT、PLT、PT、APTT等指标;产后1 h内监测有无寒颤、发热（≥38 ℃）等米索前列醇的副反应;采用集血帷帘及称重法评估产后2h内出血量;记录血压变化及有无输血. 结果 2组产妇分娩时年龄、体重、身高-体重指数、经产数、孕龄均无统计学差异（P〉0.05）.Hb、HCT、PLT、PT、APTT、血压测定在分娩前、后组间比较无统计学差异（P＞0.05）;A组产后1h寒颤（18 % vs. 4 %）、低热（≤38.5 ℃; 10 % vs. 2 %）发生率显著高于B组（P＜0.05）;2组出血量无差异,均未输血. 结论与静注10 IU缩宫素相比较,常规肛塞600μg米索前列醇预防产后出血的效果确切,推荐用于工作繁忙或条件不足的基层医院产科.

Study on rectal misoprostol versus intravenous oxytocin for prophylaxis against postpartum hemorrhage

Objective To explore the effectiveness of 600 μg of rectal misoprostol compared with an intravenous infusion of 10 IU of oxytocin as prophylaxis against postpartum hemorrhage （PPH）. Methods A total of 200 women in labor were randomized into two groups （ 100 women in each）. Within 1 minute of delivery in group A received 600 μg of rectal misoprostol and 1 ampoule of normal saline in 20 mL Ringer solution intravenously ; group B received 3 rectal placebo tablets and 10 IU of oxytocin in 20 mL Ringer solution intravenously. Hemoglobin concentration （Hb）, hematocrit value （HCT）, plastoeyte （PLT）, prothrombin time （PT）, activated partial thromboplastin time （AFIT） were measured before and 24 hrs after delivery. In the first postpartum hour, fever （≥38 ℃ ） and shivering were estimated as the adverse effects of misoprostol. And blood loss was assessed with the use of collecting drapes and weighing swabs. Whether blood pressure change and need for blood transfusion or not were recorded. Results There were no statistically significant differences between the two groups for age, weight, body mass in- dex （BMI）＇, parity, gestational age at delivery （P 〉 0.05 ）. No significant changes were observed in Hb, HCT, PLT, PT, APTT and blood pressure measurements before and after delivery in two groups （P 〉 0.05 ）. In the first postpartum hour, significantly more women in group A had fever （ ≤38.5℃; 10 % vs. 2 % , P〈0.05） and shivering （18 % vs. 4 % , P〈0.05） compared with group B. Blood loss had no significance in two groups （ P 〉 0.05 ） , and both groups were not need for blood transfusion. Conclusion Compared with intravenous infusion of 10 IU of oxytocin, routine use of 600 μg of rectal misoprostol was effective in reducing blood loss after delivery. This regimen was recommended as prophylaxis against PPH for low-resource, busy obstetric settings of the primary level hospital.