卡贝缩宫素对瘢痕子宫妊娠剖宫产后出血量、凝血指标及预后的影响

Effects of carbetocin on postpartum hemorrhage, coagulation indexes and prognosis of pregnancy in the scarred uterus after cesarean section

摘要:

目的 探讨卡贝缩宫素对瘢痕子宫妊娠剖宫产后出血量、凝血指标及预后的影响。方法 选取2017年6月—2018年12月于湖北省妇幼保健院接受剖宫产术的182例瘢痕子宫产妇，分为卡贝缩宫素组和缩宫素组。卡贝缩宫素组胎儿娩出后给予注射卡贝缩宫素，缩宫素组胎儿娩出后给予注射缩宫素。比较两组手术前后凝血指标、出血量、应激指标和术后子宫肌层厚度，统计两组不良反应率的差异。结果 卡贝缩宫素组术中、术后出血量较缩宫素组低（P <0.05）。卡贝缩宫素组MDA水平较缩宫素组低（P <0.05），SOD、GSH-px和CAT较缩宫素组高（P <0.05）。卡贝缩宫素组手术前后凝血指标差值较缩宫素组大（P <0.05）。卡贝缩宫素组术后子宫肌层厚度较缩宫素组厚（P <0.05）。两组术后不良反应率比较，差异无统计学意义（P >0.05）。结论 卡贝缩宫素用于瘢痕子宫妊娠剖宫产能有效减少出血量，缓解应激反应，改善凝血功能，提高子宫肌层厚度，且不良反应少，值得临床推广。

Abstract:

Objective To investigate the effects of carbetocin on postpartum hemorrhage, coagulation indexes and prognosis of pregnancy in the scarred uterus after cesarean section.Methods A total of 182 pregnant women with scarred uterus who underwent cesarean section in Hubei Maternity and Child Health Care Hospital were divided into carbetocin group and oxytocin group. After the delivery of fetus, the pregnant women in the carbetocin group were injected with carbetocin, and those in the oxytocin group were given oxytocin. The coagulation index, bleeding volume, and stress index before and after operation, postoperative myometrial thickness, and the adverse reaction rate were compared between the two groups.Results The amount of bleeding during operation, 2 hours after operation and 24 hours after operation in the carbetocin group was less than that in the oxytocin group (P <0.05). After operation, the level of malondialdehyde (MDA) in carbetocin group was lower than that in oxytocin group, while superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) were higher than those in oxytocin group (P < 0.05). The changes of coagulation indexes in the carbetocin group were greater than those in the oxytocin group (P < 0.05). The postoperative myometrial thickness of pregnant women in carbetocin group was greater than that in oxytocin group (P < 0.05). There was no significant difference in the rate of adverse reactions between the two groups (P > 0.05).Conclusions Carbetocin can effectively reduce the amount of bleeding, alleviate stress response, improve coagulation function, and increase the thickness of myometrium in pregnant women with scarred uterus undergoing cesarean section, but it does not increase the rate of adverse reactions, which is worthy of further clinical application.