2018 年第 10 期 第 13 卷

不同剂量缩宫素联合卡前列素氨丁三醇对高危产妇剖宫产术后出血及血流动力学的影响

Effects of different doses of oxytocin combined with carboprost tromethamine on postpartum hemorrhage and hemodynamics in high-risk parturients undergoing cesarean section

作者：袁海英高娟夏亚芳

英文作者：

单位：214400江苏省江阴市中医院南京中医药大学江阴附属医院妇产科

英文单位：

关键词：剖宫产术；高危产妇；缩宫素；卡前列素氨丁三醇；产后出血；血流动力学

英文关键词：

• 摘要：

• 【摘要】目的    探讨静脉注射不同剂量缩宫素联合宫体注射卡前列素氨丁三醇对高危产妇剖宫产术后出血及血流动力学的影响。方法    选取2016年3月至2017年12月江苏省江阴市中医院100例高危产妇，均在椎管内麻醉下行子宫下段横切口剖宫产术，依照随机数字表法分为Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组，每组25例。Ⅰ组产妇在胎儿取出后静脉注射10 ml 0.9%氯化钠注射液，Ⅱ组静脉注射缩宫素5 U，Ⅲ组静脉注射缩宫素10，Ⅳ组静脉注射缩宫素15 U；4组产妇均宫体注射卡前列素氨丁三醇250 μg。记录术中及术后2、24 h出血量，观察给药前及给药后1、3、5 min平均动脉压和心率变化。结果    术中及术后2、24 h出血量比较，Ⅱ组明显少于Ⅰ组、Ⅲ组、Ⅳ组［（241±63）ml比（368±77）、（293±77）、（326±73）ml，（195±43）ml比（287±61）、（228±54）、（256±52）ml，（462±61）ml比（592±83）、（512±77）、（546±78）ml］（P＜0.05），Ⅲ组、Ⅳ组明显少于Ⅰ组（P＜0.05）。给药前4组平均动脉压和心率比较差异无统计学意义（P＞0.05）。给药后1、3、5 min平均动脉压比较，Ⅲ组、Ⅳ组明显低于Ⅰ组、Ⅱ组［（85±6）、（84±5）mmHg（1 mmHg=0.133 kPa）比（90±7）、（89±6）mmHg，（82±7）、（81±7）mmHg比（86±6）、（86±7）mmHg，（79±6）、（79±6）mmHg比（83±7）、（84±5）mmHg］（P＜0.05）。给药后1、3、5 min心率比较，Ⅲ组、Ⅳ组明显高于Ⅰ组、Ⅱ组［（91±12）、（91±10）次/min比（84±12）、（83±9）次/min，（93±12）、（96±13）次/min比（86±7）、（86±8）次/min，（99±13）、（102±13）次/min比（90±10）、（89±11）次/min］（P＜0.05）。结论    静脉注射小剂量缩宫素（5 U）联合宫体注射卡前列素氨丁三醇能有效减少高危产妇术中及术后出血量，稳定血流动力学。

• 【Abstract】Objective    To explore the effects of intravenous injection of oxytocin at different doses combined with intrauterine injection of carboprost tromethamine on postpartum hemorrhage and hemodynamics in high-risk parturients undergoing cesarean section. Methods    Totally 100 high-risk parturients undergoing cesarean section from March 2016 to December 2017 in Traditional Chinese Medicine Hospital of Jiangyin were randomly divided into group Ⅰ, Ⅱ, Ⅲ, Ⅳ, with 25 cases in each group. After delivery, parturients in group Ⅰ had intravenous injection of 10 ml 0.9% sodium chloride solution; group Ⅱ, Ⅲ, Ⅳ had intravenous injection of 5, 10, 15 U oxytocin, respectively; all parturients had intrauterine injection of carboprost tromethamine 250 μg. Blood loss volume was recorded during operation and 2, 24 h after operation. Changes of mean arterial pressure and heart rate were observed before and 1, 3, 5 min after drug intervention. Results    Blood loss volumes during operation and 2, 24 h after operation in group Ⅱ were significantly less than those in group Ⅰ, Ⅲ, Ⅳ［（241±63）ml vs （368±77）,（293±77）,（326±73）ml; （195±43）ml vs （287±61）,（228±54）,（256±52）ml; （462±61）ml vs （592±83）,（512±77）,（546±78）ml］（P＜0.05）; blood loss volume in group Ⅲ, Ⅳ was significantly less than that in group Ⅰ（P＜0.05）. Mean arterial pressure and heart rate showed no significant differences among 4 groups before treatment（P＞0.05）. At 1, 3, 5 min after drug intervention, mean arterial pressure in group Ⅲ, Ⅳ was significantly lower than that in group Ⅰ, Ⅱ［（85±6）,（84±5）mmHg vs （90±7）,（89±6）mmHg; （82±7）,（81±7）mmHg vs （86±6）,（86±7）mmHg; （79±6）,（79±6）mmHg vs （83±7）,（84±5）mmHg］（P＜0.05）; heart rate in group Ⅲ, Ⅳ was significantly higher than that in group Ⅰ, Ⅱ［（91±12）,（91±10）times/min vs （84±12）,（83±9）times/min; （93±12）,（96±13）times/min vs （86±7）,（86±8）times/min; （99±13）,（102±13）times/min vs （90±10）,（89±11）times/min］（P＜0.05）. Conclusion    Intravenous injection of low dose oxytocin（5 U） combined with intrauterine injection of carboprost tromethamine can reduce postpartum hemorrhage and stabilize hemodynamics in high-risk parturients undergoing cesarean section.