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[1] 高娟[1] 夏亚芳[1] Yuan Haiying;Gao Juan;Xia Yafang(Department of Obstetrics and Gynecology,Traditional Chinese Medicine Hospital of Jiangyin,Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine,Jiangsu Province,Jiangyin 214400,China)

机构地区：[1]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,214400

出　　处：《中国医药》2018年第10期1567-1571,共5页China Medicine

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250μg。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。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�

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 

分 类 号：R719.8[医药卫生—妇产科学]