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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2014, Vol. 03 ›› Issue (02) : 127 -131. doi: 10.3877/cma.j.issn.2095-3259.2014.02.012

所属专题： 文献；

论著

国产卡前列素氨丁三醇防治高危产妇剖宫产出血的疗效观察
王晓怡1, 王子莲2, 钟梅3, 牛建民4, 何平5, 王晨虹6, 黄素然7, 隗伏冰8, 熊小英9, 陈敦金1,†()   
  1. 1. 510150　广州医科大学院附属第三医院妇产科
    2. 中山大学附属第一医院妇产科
    3. 南方医科大学南方医院妇产科
    4. 广东省妇幼保健院产科
    5. 广州市妇女儿童医疗中心产科
    6. 深圳市妇幼保健院产科
    7. 广东省东莞市人民医院妇产科
    8. 广东省东莞市妇幼保健院产科
    9. 广东省中山市博爱医院妇产科
  • 收稿日期:2013-11-17 出版日期:2014-05-18
  • 通信作者: 陈敦金

Study on curative effect of domestic Carboprost Tromethamine on preventing postoperative hemorrhage of high risk pregnant women with cesarean section

Xiaoyi Wang1, Zilian Wang2, Mei Zhong3, Jianmin Niu4, Ping He5, Chenhong Wang6, Suran Huang7, Fubing Kui8, Xiaoying Xiong9, Dunjin Chen1,†()   

  1. 1. Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
  • Received:2013-11-17 Published:2014-05-18
  • Corresponding author: Dunjin Chen
  • About author:
    Corresponding author: Chen Dunjin, Email:
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引用本文：

王晓怡, 王子莲, 钟梅, 牛建民, 何平, 王晨虹, 黄素然, 隗伏冰, 熊小英, 陈敦金. 国产卡前列素氨丁三醇防治高危产妇剖宫产出血的疗效观察[J]. 中华产科急救电子杂志, 2014, 03(02): 127-131.

Xiaoyi Wang, Zilian Wang, Mei Zhong, Jianmin Niu, Ping He, Chenhong Wang, Suran Huang, Fubing Kui, Xiaoying Xiong, Dunjin Chen. Study on curative effect of domestic Carboprost Tromethamine on preventing postoperative hemorrhage of high risk pregnant women with cesarean section[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2014, 03(02): 127-131.

目的

评估国产卡前列素氨丁三醇(商品名：安列克)防治高危产妇剖宫产术中及术后出血的有效性和安全性。

方法

将2011年3月至12月就诊于广东9家医院具有出血高危因素行剖宫产术的产妇360例患者，按胎儿娩出后宫体注射子宫收缩药物的不同分成3组：A组(注射缩宫素)，B组(注射缩宫素和卡前列素氨丁三醇组)，C组(注射卡前列素氨丁三醇)，每组各120例，分析比较各组术中、术后2 h及术后24 h出血量及药物副作用的情况。

结果

B组术中、术后2 h、术后24 h出血量[分别为(331.4±209.7)ml, (421.8±239.2)ml，(593.6±242.3)ml]明显低于A组[分别为(417.3±235.2)ml, (613.4±301.9)ml，(685.7±296.1)ml]，差异均有统计学意义(P<0.05)；C组[分别为(352.5±253.4)ml, (479.4±201.7)ml，(607.1±246.6)ml]也明显低于A组，差异均有统计学意义(P<0.05)；而B组与C组比较，差异均无统计学意义(P>0.05)。360例产妇，发生产后出血有42例，产后出血发生率为11.7%。A组产后出血的发生率(18.3%，22/120)明显高于B组(7.5%，9/120)和C组(9.2%，11/120), χ2＝6.145、3.596，差异均有统计学意义(P<0.05)；B组和C组治疗性宫缩剂的应用百分率[(分别为(11.1%，1/9)、(18.2%，2/11)明显少于A组(68.2%，15/22), χ2＝10.190、8.164，差异均有统计学意义(P<0.05)。360例使用宫缩剂的患者中，有27例发生1种或以上的副作用，发生率为7.5%。B组副作用的发生率(12.5%，15/120)高于A组(3.3%，4/120)和C组(6.7%，8/120), χ2＝12.451、9.254，差异均有统计学意义(P<0.05)；但各种副反应的发生率在3组患者间的比较差异均无统计学意义(P>0.05)。

结论

卡前列素氨丁三醇预防和治疗高危产妇剖宫产术中及术后出血安全有效，但要密切注意药物副作用。

关键词: 卡前列素氨丁三醇, 剖宫产术, 产后出血, 治疗结果
Objective

To evaluate the curative effect and safety of domestic Carboprost Tromethamine (trade name: An Lie ke) on preventing intraoperative hemorrhage and postoperative hemorrhage of high risk pregnant women with cesarean section.

Methods

Three hundred and sixty pregnant women, who were admitted into 9 hospitals of Guangdong province from March to December 2011, had cesarean section due to bleeding high risk factors. According to the oxytocic drugs injected in the uterine body after delivery, 360 pregnant women were divided into 3 groups: group A (only injected oxytocin), group B (injected oxytocin plus Carboprost Tromethamine) and group C (only injected Carboprost Tromethamine). There were 120 patients in each group. The amount of bleeding was observed during operation, 2 hours after operation and 24 hours after operation, respectively. The amount of bleeding in each observation time and oxytocic drug side effects of the 3 groups were compared.

Results

In group B, the amount of bleeding were (331.4±209.7)ml, (421.8±239.2)ml and (593.6±242.3)ml during operation, 2 hours after operation and 24 hours after operation, respectively, which were significantly less than those in group A[(417.3±235.2)ml, (613.4±301.9)ml and (685.7±296.1)ml] (P<0.05). In group C, the amount of bleeding were (352.5±253.4)ml, (479.4±201.7)ml and (607.1±246.6)ml during operation, 2 hours after operation and 24 hours after operation, respectively, which were also significantly less than those in group A (P<0.05). But there was no significant difference between group B and group C (P>0.05). Totally, 42 cases of 360 cases were postpartum hemorrhage, which incidence rate was 11.7%. The incidence rate of postpartum hemorrhage in group A (18.3%, 22/120) was significantly higher than that in group B(7.5%, 9/120) and group C(9.2%, 11/120), ( χ2=6.145 and 3.596, P value<0.05). The usage rate of extra oxytocic drugs was 11.1% (1/9) in group B and 18.2% (2/11) in group C, which were significantly lower than that in group A (68.2%, 15/22), ( χ2=10.190 and 8.164, P value<0.05). Among the 360 patients, 27 patients had 1 or more adverse reactions; the incidence rate was 7.5%. The incidence rate of adverse reaction in group B (12.5%, 15/120) was higher than those in group A (3.3%, 4/120) and in group C(6.7%, 8/120), ( χ2=12.451 and 9.254, P value<0.05). But the incidence rate of each side reaction had no significant difference in the 3 groups (P value>0.05).

Conclusions

Domestic Carboprost Tromethamine was effective and safe for high risk pregnant women with cesarean section to prevent intraoperative hemorrhage and postoperative hemorrhage. But the side effects need to be closely observed.

Key words: Carboprost Tromethamine, Cesarean section, Postpartum hemorrhage, Treatment outcome
表1 3组患者一般资料的比较
组别 例数 年龄(岁) 孕周(周) 孕次(次) 产次(次) 手术时间(min)
A组 120 29.1±5.3 37.9±2.0 1.9±0.7 1.9±0.7 37.9±6.2
B组 120 28.1±5.2 38.3±2.1 2.1±1.2 0.6±0.8 40.8±6.9
C组 120 27.3±5.3 38.1±1.9 2.2±1.3 0.4±0.6 40.5±7.7
F值 ? 0.621 0.239 0.503 0.347 2.382
P值 ? 0.541 0.786 0.611 0.707 0.102
组别 总例数 双胎妊娠 巨大胎儿 羊水过多 瘢痕子宫
例数 百分率(%) 例数 百分率(%) 例数 百分率(%) 例数 百分率(%)
A组 120 39 32.5 19 15.8 14 11.7 32 26.7
B组 120 43 35.8 21 17.5 16 13.3 37 30.8
C组 120 43 35.8 19 15.8 17 14.2 35 29.2
χ2值 ? ? 0.245 ? 0.673 ? 0.745 ? 0.487
P值 ? ? 0.773 ? 0.505 ? 0.487 ? 0.621
表2 3组患者术中、术后2 h、术后24 h出血量的比较(ml，±s)
出血量 术中 术后2 h 术后24 h
A组 417.3±235.2 613.4±301.9 685.7±296.1
B组 331.4±209.7 421.8±239.2 593.6±242.3
C组 352.5±253.4 479.4±201.7 607.1±246.6
F值 10.432 9.817 4.213
P值 0.009 0.010 0.021
表3 42例产后出血患者止血措施的比较(例数，%)
止血措施 例数 输血 治疗性宫缩剂 宫腔填塞 子宫动脉结扎 B-Lynch缝合 子宫动脉栓塞
例数 百分率(%) 例数 百分率(%) 例数 百分率(%) 例数 百分率(%) 例数 百分率(%) 例数 百分率(%)
A组 22 10 45.5 15 68.2 2 9.1 3 13.6 2 9.1 2 9.1
B组 9 3 33.3 1 11.1 1 11.1 0 0 0 0 0 0
C组 11 5 45.5 2 18.2 0 0 1 9.1 1 9.1 1 9.1
χ2值 ? ? 0.419 ? 12.237 ? 0.801 ? 0.406 ? 0.348 ? 0.348
P值 ? ? 0.806 ? 0.002 ? 0.672 ? 0.865 ? 0.927 ? 0.927
表4 3组患者使用宫缩剂副作用的比较(例数，%)
副作用 例数 恶心、呕吐 轻度发热 头痛 腹泻 血压升高
例数 百分率(%) 例数 百分率(%) 例数 百分率(%) 例数 百分率(%) 例数 百分率(%)
A组 4 1 25.0 0 0 0 0 0 0 3 75.0
B组 15 4 26.7 2 13.3 2 13.3 5 33.3 4 26.7
C组 8 1 12.5 1 12.5 1 12.5 3 37.5 3 37.5
χ2值 ? ? 0.380 ? 0.316 ? 0.316 ? 0.875 ? 0.591
P值 ? ? 0.731 ? 0.744 ? 0.744 ? 0.364 ? 0.544
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