产后宫缩乏力出血重在预防  

Prevention for postpartum hemorrhage due to uterine atony

作　　者：熊海燕 游华蓉 黄燕芬 杨剑芳 蒋芝蓉 

机构地区：[1]深圳市龙华新区人民医院产科,广东深圳518109

出　　处：《四川医学》2013年第4期524-526,共3页Sichuan Medical Journal

摘　　要：目的为降低产后宫缩乏力出血而探索有效的预防方法。方法收集我院2011年6月30日～2012年6月30日住院待产妇240例,随机分为试验组80例,对照组1 80例,对照组2 80例。试验组:产前,受试者予普拉睾酮200mg+5%GS 40ml缓慢静注,1次/d,共2次;分娩期,静脉补液,依次为1.平衡液500ml。2.10%GS 500ml加三磷酸腺苷(ATP)40mg。3.5%GS 500ml加维生素C 3g。分娩期间出现电解质紊乱或酸碱失衡,同时加以纠正;胎儿娩出后,立即静推缩宫素20U。对照组1:胎儿娩出后,口服米索前列醇600μg。对照组2:不予药物干预,胎儿娩出后立即按摩子宫。结果三组产程比较(min),第一产程,初产妇:试验组、对照组1和2分别为(563.15±125.08)、(682.23±123.23)、(690.14±126.54),经单因素方差分析P<0.05。经产妇:三组分别为:(326.24±98.52)、(421.18±72.60)、(419.23±84.72),P<0.05。第二产程,试验组,初产妇缩短,三组产程比较P<0.05,经产妇差异无统计学意义,P>0.05。第三产程,三组差异无统计学意义(P>0.05)。三组产后出血量(ml)试验组、对照组1和2分别为(98.62±28.51)、(197.41±47.91)、(203.79±59.62),经方差分析P<0.05。产后宫缩乏力出血>500ml,试验组0例,对照组1 2例,对照组2 2例,三组无产后出血(PPH)死亡。药物干预未出现不良反应。三组新生儿Apgar评分比较P>0.05。结论试验组产程明显缩短,无产后宫缩乏力出血发生,因此,我们认为产前普拉睾酮静脉注射,促宫颈成熟,加速分娩;分娩期静脉补充液体及能量,纠正电解质及酸碱失衡,保证子宫收缩的正常功能;胎儿娩出后静推缩宫素,加强宫缩,三者结合是预防产后宫缩乏力出血的有效方法。Objective To assess the effective methods of prevention for postpartum hemorrhage due to uterine atony. Methods 240 eligible pregnant women were randomly divided into study group 80 cases, control group 1 80 cases and control group 2 80 cases from Jun. 30,2011 to Jun. 30,2012. The subjects in study group were given prasterone 200mg ＋ 5% GS 40ml/ d ×2 by the vein at antepartum period, intravenous infusion（ CSCI 500m1,10% GS 500ml ＋ ATP 40mg,5% GS 50Oral＋ Vitc 3g） at intrapartum period, oxytocin 20U by the vein at postpartum period, and those in control group 1 were given misoprostol 600μg by the oral at postpartum period. The subjects in control group 2 were given uterine massage at postpartum period. Results The primiparae＇s first stage of labor （minute） in study group, control group 1 and 2 were （563.15 ± 125.08）, （682. 23 ± 123.23 ） , （690. 14 ± 126. 54 ） respectively P 〈 0. 05, and the muhiparae＇s first stage of labor were （326. 24 ± 98. 52 ）, （421.18 ± 72. 60 ）, （419. 23 ±84. 72） respectively P 〈0. 05. The primiparae＇s second stage of labor among three groups have significance P 〈0. 05 while the multiparae＇s second stage of labor anaong three groups have no significance P 〉 0. 05. The third stage of labor among three groups have no significance either P 〉 0.05. The blood loss （ml） at postpartum period in study group, control group 1 and 2 were （98. 62 ±28.51 ） ,（ 197.41 ±47.91 ） ,（203.79 ±59.62） respectively P 〈0.05. There was no the case of PPH due to uterine atony in study group while there were 2 cases of PPH due to uterine atony in control group 1 and 2 cases in control group 2. There was no side-effects due to prasterone. The neonatal Apgar scores among three groups have no significance P 〉 0. 05. Conclusion The stage of labor was shortened obviously and no PPH due to uterine atony occurred in study group, so we think that prasterone by the vein to promote the cervix maturity at antepartum period combined with intrave

关 键 词：产后宫缩乏力出血 预防 普拉睾酮 静脉补液 缩宫素 

分 类 号：R714.461[医药卫生—妇产科学]