术中应用垂体后叶素在大子宫切除术围术期血液管理中的作用研究  

Role of vasopressin in perioperative blood management in hysterectomy for large uterus

作　　者：王馨犹 李亚 韩世超[1] 王军 那晶 WANG Xin-you;LI Ya;HAN Shi-chao;WANG Jun;NA Jing(Department of Obstetrics and Gynecology,the Second Affiliated Hospital of Dalian Medical University,Dalian 116000,China)

机构地区：[1]大连医科大学附属第二医院妇产科,辽宁大连116000

出　　处：《中国实用妇科与产科杂志》2022年第6期661-664,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：辽宁省科学技术计划面上项目(2015020719)。

摘　　要：目的 探讨垂体后叶素在大子宫切除术围术期血液管理中的应用价值。方法 回顾性分析2021年1月至12月于大连医科大学附属第二医院行腹腔镜下大子宫切除术的患者87例,纳入的患者均为合并多发性子宫肌瘤或子宫腺肌病,且无生育要求的育龄期女性,子宫体积均大于孕12周(子宫底高度高于耻骨联合上2cm),均行腹腔镜下全子宫切除术。根据术中是否应用垂体后叶素分为两组:观察组为术中给予垂体后叶素后行腹腔镜全子宫切除术的患者,共53例;对照组术中未用药,共34例。两组根据术前是否合并继发性贫血,进一步分为贫血组及无贫血组。比较各组患者术中循环指标、围术期相关指标、并发症发生情况及术后输血情况。结果 观察组用药后收缩压(SBP)、舒张压(DBP)、心率(HR)均发生波动,用药后5min观察组SBP及DBP高于用药前,HR低于用药前(P<0.05),其余时刻用药前后差异无统计学意义。观察组手术时间、肠道功能恢复时间及术后住院时间均短于对照组,术中出血量、手术前后血红蛋白及红细胞压积变化、术后输血治疗比例均低于对照组(P<0.05)。结论 术中注射垂体后叶素后行腹腔镜大子宫切除术可提高止血效果,缩短痊愈时间,减少围术期应激反应及因子宫切除导致的循环血量丢失,维持血红蛋白稳定,降低输血治疗率,在围术期血液管理中具有确切疗效,且安全性较高。Objective To explore the application value of vasopressin in perioperative blood management inhysterectomy for large uterus.Methods A total of 87 patients who underwent laparoscopic hysterectomy for large uterus from January 2021 to December 2021 were included in this retrospective analysis.The included patients were all reproductive-age women who did not have reproductive requirements and were with multiple uterine myoma or adenomyosis.All patients’uterine volume was larger than that of 12 weeks of gestation(the height of the uterine fundus was higher than 2cm above the pubic symphysis).All the underwent laparoscopists hysterectomy.Patients are divided into two groups,according to whether the vasopressin was used in the operation or not.The observation group included 53patients who were given the vasopressin during the operation.The control group included 34 patients who weren’t given the vasopressin during the operation.The two groups were further divided into anemia group and normal group according to whether secondary anemia existed before the operation.Intraoperative circulation indicators,perioperative related indicators,complications and postoperative blood transfusion were compared among the four groups.Results The blood pressure(including SBP and DBP)and heart rate of the observation group fluctuated after using vasopressin during the operation.At 5 minutes after the medication,the blood pressure(SBP and DBP)of the observation group was higher than those before the medication,and the heart rate was lower(P<0.05).There were no differences in blood pressure or heart rate between before and after the medication at other moments.The operation time,bowel function recovery time and postoperative hospital stay were all shorter in observation group than in the control group,and the intraoperative bleeding,and hemoglobin and hematocrit changes before and after operation were all lower;the proportion of postoperative blood transfusion in the observation group was less than that in the control group.Conclusion

关 键 词：血液管理 大子宫 全子宫切除术 垂体后叶素 

分 类 号：R713.4[医药卫生—妇产科学]