注射用血凝酶联合卡前列素氨丁三醇对宫缩乏力性产后出血患者纤溶、凝血功能的影响

Effect of hemocoagulase injection combined with carboprost tromethamine on fibrinolysis and coagulation in patients with postpartum hemorrhage due to uterine atony

摘要:

目的 探讨注射用血凝酶联合卡前列素氨丁三醇对宫缩乏力性产后出血（PPH）患者纤溶、凝血功能的影响。方法 选取2020年6月—2022年6月海南省中医院收治的76例宫缩乏力性产后出血（PPH）患者，随机分为对照组和研究组，每组38例。对照组采用卡前列素氨丁三醇治疗，研究组采用注射用血凝酶联合卡前列素氨丁三醇治疗，比较两组产后2 h出血量、产后24 h出血量、止血时间，宫缩程度，临床疗效，脑钠肽（BNP）、一氧化氮（NO）、一氧化氮合酶（NOS），纤溶功能指标、凝血功能指标及不良反应。结果 研究组产后2 h出血量、产后24 h出血量少于对照组（P <0.05），止血时间短于对照组（P <0.05）。研究组与对照组患者用药10、20、30 min宫缩程度比较，结果 ①不同时间点宫缩程度有差异（F =15.492，P =0.000）。②研究组与对照组宫缩程度有差异（F =71.063，P =0.000），研究组宫缩程度较高，宫缩效果较好。③两组宫缩程度变化趋势有差异（F =13.285，P =0.000）。研究组总有效率高于对照组（P <0.05）。研究组治疗前后血清BNP、NO、NOS、血小板、血红蛋白、凝血酶时间、凝血酶原时间、活化部分凝血活酶时间、D-二聚体、纤维蛋白原的差值高于对照组（P <0.05）。两组不良反应发生率比较，差异无统计意义（P >0.05）。结论 注射用血凝酶联合卡前列素氨丁三醇用于治疗宫缩乏力性PPH患者可以减少产后出血，改善纤溶、凝血功能，且安全可靠。

Abstract:

Objective To explore the effect of hemocoagulase injection combined with carboprost tromethamine on fibrinolysis and coagulation in patients with postpartum hemorrhage (PPH) due to uterine atony.Methods A total of 76 patients with PPH caused by uterine atony admitted to our hospital from June 2020 to June 2022 were selected and randomly divided into control group (n = 38 cases) and study group (n = 38 cases). The control group was treated with carboprost tromethamine, and the study group was treated with hemocoagulase injection and carboprost tromethamine. The volume of blood loss at 2 hours and 24 hours after delivery, time to hemostasis, strength of uterine contraction, clinical efficacy, brain natriuretic peptide (BNP), nitric oxide (NO), nitric oxide synthase (NOS), fibrinolytic function indicators, coagulation function indicators and adverse reactions of the two groups were compared.Results The volume of blood loss at 2 hours and 24 hours after delivery in the study group was lower than that in the control group (P < 0.05), while the time to hemostasis in the study group was shorter than that in the control group (P < 0.05). The strength of uterine contraction after 10 min, 20 min and 30 min of medication in the study group and the control group was compared via repeated measures ANOVA, and the results revealed that there was a difference in the strength of uterine contraction among different time points (F =15.492, P =0.000) and between the study group and the control group (F =71.063, P =0.000). Compared with the control group, the strength of uterine contraction in the study group was higher. Besides, the change trends of the strength of uterine contraction were different between the study group and the control group (F =13.285, P =0.000). The overall effective rate of the study group was higher than that of the control group (P < 0.05). The differences of serum levels of BNP, NO, and NOS, the platelet count, the level of hemoglobin, thrombin time, prothrombin time, activated partial thromboplastin time, and the levels of D-dimer and fibrinogen before and after the treatment were higher in the study group compared with the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).Conclusions Hemocoagulase injection combined with carboprost tromethamine reduces postpartum hemorrhage and improves fibrinolysis and coagulation functions of patients with few safety concerns in the treatment of PPH caused by uterine atony.