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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2018, Vol. 07 ›› Issue (03) : 180 -184. doi: 10.3877/cma.j.issn.2095-3259.2018.03.014

所属专题： 文献；

论著

麦角新碱预防高危孕产妇剖宫产出血的疗效观察
钟柳英1, 陈敦金1,†(), 纪艳洁2, 王刚3, 侯红瑛4, 尹保民5, 代炳梅6, 张卫社7, 何东梅8, 高玲9, 丁桂凤10, 朱启英11, 何津12, 阴春霞13, 许吟14, 高万里15, 杨金英16   
  1. 1. 510150　广州医科大学附属第三医院产科
    2. 523721　广东，东莞塘厦医院妇产科
    3. 528000　广东，佛山市第一人民医院妇产科
    4. 510635　广州，中山三院爱博恩医疗中心产科
    5. 519001　广东，珠海妇幼保健院妇产科
    6. 523112　广东，东莞妇幼保健院妇产科
    7. 410008　长沙，中南大学湘雅医院妇产科
    8. 835000　伊宁，新疆生产建设兵团农四师医院妇产科
    9. 843000　阿克苏，新疆生产建设兵团农一师医院妇产科
    10. 830001　乌鲁木齐市妇幼保健院妇产科
    11. 830054　乌鲁木齐，新疆医科大学第一附属医院妇产科
    12. 130021　长春，吉林大学白求恩第一医院产科
    13. 140052　长春市妇产医院产科
    14. 550002　贵阳，贵州省人民医院产科
    15. 102600　北京大兴区人民医院妇产科
    16. 150080　哈尔滨，哈尔滨南岗区妇产医院产科
  • 收稿日期:2018-01-28 出版日期:2018-08-18
  • 通信作者: 陈敦金

Efficacy of ergonovine in preventing hemorrhage of cesarean section in high-risk pregnant women

Liuying Zhong1, Dunjin Chen1,†(), Yanjie Ji2, Gang Wang3, Hongying Hou4, Baoming Yin5, Bingmei Dai6, Weishe Zhang7, Dongmei He8, Ling Gao9, Guifeng Ding10, Qiying Zhu11, Jin He12, Chunxia Yin13, Yin Xu14, Wanli Gao15, Jinying Yang16   

  1. 1. Department of Obstetrics, Third Affiliated Hospital of Guangzhou Medical University, 510150 Guangzhou, China
    2. Department of Obstetrics and Gynecology, Dongguan Tangxia Hospital, 523721 Guangdong, China
    3. Department of Obstetrics and Gynecology, Foshan First People′s Hospital, 528000 Guandong, China
    4. Department of Obstetrics, iBorn Women′s & Chidren′s Hospital, 510635 Guangzhou, China
    5. Department of Obstetrics and Gynecology, Zhuhai Maternal and Child Health Hospital, 519001 Guangdong, China
    6. Department of Obstetrics and Gynecology, Dongguan Maternal and Child Health Hospital, 523112 Guangdong, China
    7. Department of Obstetrics, Central South University Xiangya Hospital, 410008 Changsha, China
    8. Department of Obstetrics and Gynecology, BING TUAN DI SI SHI YI YUAN, 835000 Yining, China
    9. Department of Obstetrics and Gynecology, First Agricultural Division Of Xinjiang Production And Construction Corps, 843000 Aksu, China
    10. Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital of Xinjiang Uygur Autonomous Region 830001 Urumqi, China
    11. Department of Obstetrics, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, China
    12. Department of Obstetrics and Gynecology, Jilin University Bethune First Hospital, 130021 Changchun, China
    13. Department of Obstetrics and Gynecology, Changchun Obstetrics and Gynecology Hospital, 140052 Changchun, China
    14. Department of Obstetrics and Gynecology, Guizhou Provincial People′s Hospital, 550002 Guiyang, China
    15. Department of Obstetrics and Gynecology, Daxing District People′s Hospital, 102600 Beijing, China
    16. Department of Obstetrics and Gynecology, Harbin Nangang District Obstetrics and Gynecology Hospital, 150080 Harbin, China
  • Received:2018-01-28 Published:2018-08-18
  • Corresponding author: Dunjin Chen
  • About author:
    Corresponding author: Chen Dunjin, Email:
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引用本文：

钟柳英, 陈敦金, 纪艳洁, 王刚, 侯红瑛, 尹保民, 代炳梅, 张卫社, 何东梅, 高玲, 丁桂凤, 朱启英, 何津, 阴春霞, 许吟, 高万里, 杨金英. 麦角新碱预防高危孕产妇剖宫产出血的疗效观察[J]. 中华产科急救电子杂志, 2018, 07(03): 180-184.

Liuying Zhong, Dunjin Chen, Yanjie Ji, Gang Wang, Hongying Hou, Baoming Yin, Bingmei Dai, Weishe Zhang, Dongmei He, Ling Gao, Guifeng Ding, Qiying Zhu, Jin He, Chunxia Yin, Yin Xu, Wanli Gao, Jinying Yang. Efficacy of ergonovine in preventing hemorrhage of cesarean section in high-risk pregnant women[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2018, 07(03): 180-184.

目的

评估麦角新碱预防高危孕妇剖宫产术中及术后出血的有效性和安全性。

方法

收集2017年2月至6月就诊于全国16家医院具有出血高危因素行剖宫产术的产妇1074例。按使用不同宫缩将患者分成3组，研究组Ⅰ(384例，术中注射缩宫素＋麦角新碱，术后注射缩宫素)，研究组Ⅱ(340例，术中注射缩宫素＋麦角新碱，术后注射麦角新碱)，对照组(350例，术中和术后注射缩宫素)，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。采用方差分析和χ2检验对数据进行统计学分析。

结果

研究组Ⅱ术中出血量，术后2 h和术后24 h出血增量分别为(400.09±203.82)ml、(31.76±27.83)ml和(60.74±55.27)ml，明显低于研究组Ⅰ的(451.33±441.43)ml、(66.30±43.08)ml和(83.62±56.89)ml，差异均有统计学意义(P<0.05)。研究组Ⅱ使用治疗性宫缩剂为18例(5.29%)，分别低于研究组Ⅰ89例(23.18%)和对照组102例(29.14%)，q＝3.90和4.32，差异均有统计学意义(P<0.05)。

结论

麦角新碱预防高危孕产妇剖宫产术中和术后出血安全有效，但药物不良反应要密切注意。

关键词: 麦角新碱, 剖宫产术, 妊娠，高危
Objective

To evaluate the curative effect and safety of ergonovine in preventing bleeding during and after cesarean section in high risk pregnant women.

Methods

One thousand and seventy-four parturients with high risk factors of bleeding who underwent cesarean section in 16 hospitals of China were collected from February to June 2017. Patients were divided into three groups according to the use of different uterine contraction agents: group I (384 cases, oxytocin plus ergonovine were injected intraoperatively, oxytocin was injected after operation), group II (340 cases, oxytocin plus ergonovine were injected intraoperatively, ergonovine was injected after operation), control group (350 cases, oxytocin was injected intraoperatively and after operation). The bleeding volume and side effects of the operation, 2 h and 24 h after operation were analyzed and compared. Analysis of variance or Chi-square test was used for statistical analysis.

Results

In group II, the amount of blood loss of the operation, 2 h and 24 h after operation were (400.09±203.82) ml, (31.76±27.83)ml, (60.74±55.27)ml, respectively, which were significantly less than those in group I (451.33±441.43) ml, (66.30±43.08)ml, (83.62±56.89)ml, (P<0.05). The incidence rate of the patients used uterine contraction agent in group II was 5.29% (18 cases), which was smaller than those in group I (23.18%, 89 cases) and in the control group (29.14%, 102 cases), q=3.90 and 4.32, respectively, and P less than 0.05.

Conclusion

Ergonovine was effective and safe for high risk pregnant women with cesarean section to prevent intraoperative hemorrhage and postoperative hemorrhage, but close attention should be paid to the adverse drug reaction.

Key words: Ergonovine, Cesarean section, Pregnancy, high-risk
表1 3组患者一般资料的比较
组别 例数 瘢痕子宫[例(%)] 多胎妊娠[例(%)] 巨大儿[例(%)] 前置胎盘[例(%)] 羊水过多[例(%)] 其他*[例(%)]
研究组Ⅰ 384 173(45.05) 52(13.54) 100(26.04) 27(7.03) 12(3.13) 20(5.21)
研究组Ⅱ 340 156(45.88) 48(14.12) 91(26.76) 20(5.88) 10(2.94) 15(4.41)
对照组 350 168(48.00) 45(12.86) 92(26.29) 20(5.71) 9(2.57) 16(4.57)
χ2值 ? 2.65 2.63 2.65 1.19 1.07 0.08
P值 ? 0.157 0.159 0.157 0.335 0.399 0.789
表2 3组患者术中和术后出血量的比较(ml)
组别 例数 术中出血 术后2 h出血增量 术后24 h出血增量
研究组Ⅰ 384 300(200，500) 70(40，335)a 200(75，474)d
研究组Ⅱ 340 300(225，550) 50(20，273.75)bc 170(50，193.75)ef
对照组 350 300(210，410) 150(50，400) 375(260，550)
F值 ? 3.827 13.109 14.763
P值 ? 0.148 0.001 0.010
表3 产后出血患者止血措施的比较[例(%)]
组别 例数 产后出血 输血 子宫缝合 宫腔填塞 使用治疗性宫缩剂
研究组Ⅰ 384 30(7.81) 4(1.04) 20(5.20) 6(1.56) 89(23.18)a
研究组Ⅱ 340 13(3.82) 2(0.59) 5(1.47) 2(0.59) 18(5.29)bc
对照组 350 41(11.71) 6(1.71) 14(4.00) 10(2.86) 102(29.14)
χ2值 ? － － － － 67.00
P值 ? － － － － <0.01
表4 3组患者使用宫缩剂发生不良反应情况(例)
组别 例数 恶心 头痛 心率加快 心率变缓 高血压
研究组Ⅰ 23 10 7 2 5 1
研究组Ⅱ 21 9 3 4 6 2
对照组 13 4 5 2 2 0
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