麦角新碱联合子宫捆绑术对宫缩乏力性产后出血产妇凝血功能和卵巢功能的影响  

Effects of ergometrine combined with uterine binding on coagulation function and ovarian function in puerperae with postpartum hemorrhage induced by uterine atony

作　　者：聂桂兰 范徐妃[2] 王春茶 于辉兰 范俊霞 NIE Gui-lan;FAN Xu-fei;WANG Chun-cha;YU Hui-lan;FAN Jun-xia(Department of Obstetrics and Gynecology,Jinhua Maternal and Child Health Hospital,Jinhua,Zhejiang 321000,China;不详)

机构地区：[1]金华市妇幼保健院妇产科,浙江金华321000 [2]金华市中心医院产科

出　　处：《中国妇幼保健》2023年第18期3395-3400,共6页Maternal and Child Health Care of China

基　　金：浙江省基础公益研究计划项目(LQ19H040002);浙江省金华市科学计划研究项目(2019-4-079)。

摘　　要：目的探讨麦角新碱联合子宫捆绑术对宫缩乏力性产后出血(PPH)产妇凝血功能、卵巢功能的影响。方法选取2018年3月—2022年3月金华市妇幼保健院收治的90例宫缩乏力性PPH产妇为对象,按照随机数表法分为对照组(45例)和治疗组(45例),对照组予以麦角新碱联合纱布填塞术治疗,治疗组予以麦角新碱联合子宫捆绑术治疗。比较两组产妇术后2、12、24 h出血量、住院时间、恶露持续时间、月经复潮时间、术前和术后2 h凝血功能指标[D-二聚体(D-D)、纤维蛋白原(FIB)、凝血酶原时间(PT)、凝血酶时间(TT)]、术前和术后3 d卵巢功能指标[雌二醇(E_(2))、卵泡刺激素(FSH)、促黄体生成素(LH)]、术前和术后3 d应激反应指标[去甲肾上腺素(NE)、肾上腺素(E)、醛固酮(ALD)、血管紧张素Ⅱ(ANGⅡ)]、术前和术后3 d生化指标[一氧化氮(NO)、一氧化氮合酶(NOS)]及术后并发症发生情况。结果治疗组术后2、12、24 h出血量分别为(193.98±35.21)ml、(236.76±40.62)ml、(275.87±43.25)ml,显著低于对照组的(382.21±41.62)ml、(412.46±37.29)ml、(453.28±45.56)ml,差异均有统计学意义(t=12.374、21.561、12.431,均P<0.05);治疗组住院时间、恶露持续时间、月经复潮时间分别为(5.15±0.94)d、(29.96±4.01)d、(175.60±46.54)d,低于对照组的(6.22±1.18)d、(33.12±4.77)d、(198.42±51.03)d,差异均有统计学意义(t=4.758、3.402、2.029,均P<0.05);术后2 h,治疗组D-D和FIB水平分别为(193.87±34.24)ng/ml、(2.78±0.53)g/L,显著高于对照组的(172.64±29.32)ng/ml、(2.15±0.30)g/L,PT和TT水平分别为(13.16±2.13)s、(16.07±2.34)s,显著低于对照组的(16.42±2.36)s、(19.69±2.23)s,差异均有统计学意义(t=3.159、6.939、6.879、7.513,均P<0.05);术后3 d,治疗组E_(2)、FSH和LH水平分别为(253.49±14.61)pmol/L、(4.91±0.84)IU/L、(5.80±1.46)IU/L,和对照组的(254.31±15.30)pmol/L、(4.96±0.45)IU/L、(5.63±1.28)IU/L比较,差异无统计学意义(P>0.05);术后Objective To explore the effects of ergometrine combined with uterine binding on coagulation function and ovarian function in puerperae with postpartum hemorrhage(PPH)induced by uterine atony.Methods A total of 90 puerperae with PPH induced by uterine atony admitted to the Jinhua Maternal and Child health hospital were enrolled as the research objects between March 2018 and March 2022.They were randomly divided into control group(45 case)and treatment group(45 case)according to the random number table meth-od.All were treated with ergometrine.On this basis,control group was given gauze packing,while treatment group was treated with uterine binding.The blood loss at 2 h,12 h and 24 h after surgery,hospital stay,duration of malignant discharge,and time to return to menstrua-tion,coagulation function indexes[D-dimer(D-D),fibrinogen(FIB),prothrombin time(PT),thrombin time(TT)]before and at 2 h after surgery,ovarian function indexes[estradiol(E 2),follicle-stimulating hormone(FSH),luteinizing hormone(LH)]before and at 3 dafter surgery,stress response indicators[norepinephrine(NE),epinephrine(E),aldosterone(ALD),angiotensinⅡ(ANGⅡ)]be-fore and at 3 d after surgery,biochemical indicators[nitric oxide(NO),nitric oxide synthase(NOS)]before and at 3d after surgery and occurrence of postoperative complications were compared between the two groups.Results At 2 h,12 h and 24 h after surgery,blood loss in treatment group was(193.98±35.21)ml,(236.76±40.62)ml and(275.87±43.25)ml,less than that in control group[(382.21±41.62)ml,(412.46±37.29)ml,(453.28±45.56)ml],there were statistically significant differences(t=12.374,21.561,12.431,P<0.05).The length of hospital stay,duration of malignant discharge,and time to return to menstruation in the treatment group were(5.15±0.94)d,(29.96±4.01)d,and(175.60±46.54)d,respectively,which were lower than those in the control group of(6.22±1.18)d,(33.12±4.77)d,and(198.42±51.03)d,the differences are statistically significant(t=4.758,3.402,2.029,all P<0.05).At 2 h after surgery,leve

关 键 词：宫缩乏力 产后出血 麦角新碱 子宫捆绑术 凝血功能 卵巢功能 

分 类 号：R714[医药卫生—妇产科学]