止血带联合子宫背带式缝合术对剖宫产出血患者应激反应和凝血及纤溶功能的影响  

Effect of tourniquet combined with uterine strap suture on stress response,coagulation and fibrinolytic function in patients with postpartum cesarean section hemorrhage

作　　者：姚灵梅 陈俐 余美红 YAO Lingmei;CHEN Li;YU Meihong(Department of Obstetrics and Gynecology,Shangrao Maternal and Child Health Hospital,Shangrao,Jiangxi,334000,China)

机构地区：[1]上饶市妇幼保健院妇产科,江西上饶334000

出　　处：《当代医学》2024年第25期97-101,共5页Contemporary Medicine

摘　　要：目的探究止血带联合子宫背带式缝合术对剖宫产出血患者围手术期出血量、应激反应、凝血功能及纤溶功能的影响。方法选取2021年12月至2022年12月上饶市妇幼保健院收治的60例剖宫产出血患者作为研究对象,随机分为观察组与对照组,每组30例。对照组采取子宫背带式缝合术,观察组采取止血带联合子宫背带式缝合术。比较两组围手术期出血量、手术时间、应激反应[去甲肾上腺素(norepinephrine,NE)、血管紧张素Ⅱ(AngiotensinⅡ,AngⅡ)]、凝血功能[凝血酶原时间(prothrombin time,PT)、D-二聚体(D-dimer,D-D)、凝血酶时间(thrombin time,TT)、活化部分凝血酶时间(activated partial thromboplastin time,APTT)]、纤溶功能[血小板计数(platelet count,PLT)、血红蛋白(hemoglobin,Hb)]。结果观察组术中出血量、术后24 h出血量均少于对照组,手术时间短于对照组,差异有统计学意义(P<0.05)。术中、术后24 h,两组NE、AngⅡ水平均高于术前,呼吸频率、心率均快于术前,术后24 h,两组NE、AngⅡ水平均低于术中,呼吸频率、心率均慢于术前,差异有统计学意义(P<0.05);术中、术后24 h,观察组NE、AngⅡ水平均低于对照组,呼吸频率、心率均慢于对照组,差异有统计学意义(P<0.05)。术中、术后24 h,两组PT、TT、APTT均短于术前,D-D水平均低于术前,术后24 h,PT、TT、APTT均短于术中,D-D均高于术中,差异有统计学意义(P<0.05);术中、术后24 h,观察组PT、TT、APTT均短于对照组,D-D水平高于对照组,差异有统计学意义(P<0.05)。术中、术后24 h,两组PLT、Hb水平均低于术前,且术后24 h高于术中,差异有统计学意义(P<0.05);术中、术后24 h,观察组PLT、Hb水平均高于对照组,差异有统计学意义(P<0.05)。结论与单独应用子宫背带式缝合术相比,止血带联合子宫背带式缝合术治疗剖宫产出血可减少患者围手术期出血量,缩短手术时间,减轻应激反应,改善其凝血功能与Objective To explore the effects of tourniquet combined with uterine strap suture on perioperative blood loss,stress response,coagu-lation function and fibrinolytic function in patients with cesarean section hemorrhage.Methods 60 cases of patients with cesarean section hemor-rhage admitted to Shangrao Maternal and Child Health Hospital from December 2021 to December 2022 were selected as the study subjects,and they were randomly divided into the observation group and the control group,with 30 cases in each group.The control group was treated with uterine strap suture,and the observation group was treated with tourniquet combined with uterine strap suture.The perioperative blood loss,operation time,stress response(norepinephrine[NE],AngiotensinⅡ[AngⅡ]),coagulation function(prothrombin time[PT],D-dimer[D-D],thrombin time[TT],activated partial thromboplastin time[APTT]),fibrinolysis function(platelet count[PLT],hemoglobin[Hb])were compared between the two groups.Results The intraoperative blood loss and postoperative 24 h blood loss in the observation group were less than those in the control group,and the operation time was shorter than that in the control group,the differences were statistically significant(P<0.05).During operation and 24 h after op-eration,NE and AngⅡof the two groups were higher than those before operation,respiratory rate and heart rate were faster than those before opera-tion,at 24 h after operation,NE and AngⅡof the two groups were lower than those during operation,respiratory rate and heart rate were slower than those before operation,the differences were statistically significant(P<0.05);during operation and 24 h after operation,NE and AngⅡin the observation group were lower than those in the control group,respiratory rate and heart rate were slower than those in the control group,and the dif-ferences were statistically significant(P<0.05).During operation and 24 h after operation,PT,TT and APTT of the two groups were shorter than those before operation,and D-D was lower than that

关 键 词：止血带 子宫背带式缝合术 剖宫产出血 应激反应 凝血功能 纤溶功能 

分 类 号：R47[医药卫生—护理学]