中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2009年
3期
175-178
,共4页
目的 探讨剖宫产术中应用益母草注射液预防产后出血的有效性和安全性.方法 采用多中心、随机、单盲、阳性药物对照的前瞻性研究方法,于2007年4至8月,选择全国15所三级医院440例因产科医学指征行剖宫产分娩的产妇为研究对象.其中益母草组147例,于胎儿娩出后子宫肌壁注射益母草注射液40 mg,术后2 h开始,益母草注射液臀部肌内注射,20 mg/12 h,共3次;益母草+缩官素组144例,于胎儿娩出后子宫肌壁注射益母草注射液40 mg及缩宫素10 U,术后2 h开始,益母草注射液臀部肌内注射,20 mg/12 h,共3次;缩宫素组149例,胎儿娩出后子宫肌壁注射缩宫素10 U,同时静脉滴注缩宫素10 U(加入5%葡萄糖液500 ml中),术后2 h开始,缩宫素臀部肌内注射,10 U/12 h,共3次.观察:(1)产时出血量、产后2、6、12、24、48 h的阴道出血量;(2)产后24 h总出血量和产后出血发生率;(3)产前及产后血红蛋白、红细胞计数的差值;(4)不良反应.结果(1)出血量:平均产时出血量益母草组为(368±258)ml,缩宫素组为(269±14t)ml,益母草+缩宫素组为(255±114)ml,3组的产时出血量分别比较,差异均有统计学意义(P<0.01);产后2、6、12、24、48 h各组阴道出血量比较,差异均无统计学意义(P>0.05).(2)产后24 h总出血量:产后24 h总出血量益母草组平均为(480±276)ml、益母草+缩宫素组为(361±179)ml、缩宫素组为(381±179)ml,3组术后24 h总出血量分别比较,差异也有统计学意义(P<0.01).(3)产后出血发生率:产后出血发生率益母草组为32.0%(47/147)、益母草+缩宫素组为11.1%(16/144)、缩宫素组为18.8%(28/149),益母草+缩宫素组产后出血发生率最低,而益母草组产后出血发生率最高,两组比较,差异有统计学意义(P<0.01).(4)产前及产后血红蛋白、红细胞计数:各组产后与产前比较,红细胞计数和血红蛋白水平均有不同程度的下降,其中益母草组红细胞计数差值为(0.3±0.5)×1012/L,血红蛋白差值为(9±13)g/L;益母草+缩宫素组红细胞计数差值为(0.2±0.4)×1012/L,血红蛋白差值为(6±10)g/L;缩宫素组红细胞计数差值为(0.2±0.4)×10124/L,血红蛋白差值为(7±30)g/L,缩宫素组、益母草+缩宫素组分别与益母草组比较,差异均有统计学意义(P<0.05);益母草+缩宫素组血红蛋白下降程度最低.(5)不良反应:3组中共有2例发生轻度过敏反应.结论剖宫产术中应用益母草注射液联合缩宫素,可明显预防产后出血的发生,且药物安全性好.
目的 探討剖宮產術中應用益母草註射液預防產後齣血的有效性和安全性.方法 採用多中心、隨機、單盲、暘性藥物對照的前瞻性研究方法,于2007年4至8月,選擇全國15所三級醫院440例因產科醫學指徵行剖宮產分娩的產婦為研究對象.其中益母草組147例,于胎兒娩齣後子宮肌壁註射益母草註射液40 mg,術後2 h開始,益母草註射液臀部肌內註射,20 mg/12 h,共3次;益母草+縮官素組144例,于胎兒娩齣後子宮肌壁註射益母草註射液40 mg及縮宮素10 U,術後2 h開始,益母草註射液臀部肌內註射,20 mg/12 h,共3次;縮宮素組149例,胎兒娩齣後子宮肌壁註射縮宮素10 U,同時靜脈滴註縮宮素10 U(加入5%葡萄糖液500 ml中),術後2 h開始,縮宮素臀部肌內註射,10 U/12 h,共3次.觀察:(1)產時齣血量、產後2、6、12、24、48 h的陰道齣血量;(2)產後24 h總齣血量和產後齣血髮生率;(3)產前及產後血紅蛋白、紅細胞計數的差值;(4)不良反應.結果(1)齣血量:平均產時齣血量益母草組為(368±258)ml,縮宮素組為(269±14t)ml,益母草+縮宮素組為(255±114)ml,3組的產時齣血量分彆比較,差異均有統計學意義(P<0.01);產後2、6、12、24、48 h各組陰道齣血量比較,差異均無統計學意義(P>0.05).(2)產後24 h總齣血量:產後24 h總齣血量益母草組平均為(480±276)ml、益母草+縮宮素組為(361±179)ml、縮宮素組為(381±179)ml,3組術後24 h總齣血量分彆比較,差異也有統計學意義(P<0.01).(3)產後齣血髮生率:產後齣血髮生率益母草組為32.0%(47/147)、益母草+縮宮素組為11.1%(16/144)、縮宮素組為18.8%(28/149),益母草+縮宮素組產後齣血髮生率最低,而益母草組產後齣血髮生率最高,兩組比較,差異有統計學意義(P<0.01).(4)產前及產後血紅蛋白、紅細胞計數:各組產後與產前比較,紅細胞計數和血紅蛋白水平均有不同程度的下降,其中益母草組紅細胞計數差值為(0.3±0.5)×1012/L,血紅蛋白差值為(9±13)g/L;益母草+縮宮素組紅細胞計數差值為(0.2±0.4)×1012/L,血紅蛋白差值為(6±10)g/L;縮宮素組紅細胞計數差值為(0.2±0.4)×10124/L,血紅蛋白差值為(7±30)g/L,縮宮素組、益母草+縮宮素組分彆與益母草組比較,差異均有統計學意義(P<0.05);益母草+縮宮素組血紅蛋白下降程度最低.(5)不良反應:3組中共有2例髮生輕度過敏反應.結論剖宮產術中應用益母草註射液聯閤縮宮素,可明顯預防產後齣血的髮生,且藥物安全性好.
목적 탐토부궁산술중응용익모초주사액예방산후출혈적유효성화안전성.방법 채용다중심、수궤、단맹、양성약물대조적전첨성연구방법,우2007년4지8월,선택전국15소삼급의원440례인산과의학지정행부궁산분면적산부위연구대상.기중익모초조147례,우태인면출후자궁기벽주사익모초주사액40 mg,술후2 h개시,익모초주사액둔부기내주사,20 mg/12 h,공3차;익모초+축관소조144례,우태인면출후자궁기벽주사익모초주사액40 mg급축궁소10 U,술후2 h개시,익모초주사액둔부기내주사,20 mg/12 h,공3차;축궁소조149례,태인면출후자궁기벽주사축궁소10 U,동시정맥적주축궁소10 U(가입5%포도당액500 ml중),술후2 h개시,축궁소둔부기내주사,10 U/12 h,공3차.관찰:(1)산시출혈량、산후2、6、12、24、48 h적음도출혈량;(2)산후24 h총출혈량화산후출혈발생솔;(3)산전급산후혈홍단백、홍세포계수적차치;(4)불량반응.결과(1)출혈량:평균산시출혈량익모초조위(368±258)ml,축궁소조위(269±14t)ml,익모초+축궁소조위(255±114)ml,3조적산시출혈량분별비교,차이균유통계학의의(P<0.01);산후2、6、12、24、48 h각조음도출혈량비교,차이균무통계학의의(P>0.05).(2)산후24 h총출혈량:산후24 h총출혈량익모초조평균위(480±276)ml、익모초+축궁소조위(361±179)ml、축궁소조위(381±179)ml,3조술후24 h총출혈량분별비교,차이야유통계학의의(P<0.01).(3)산후출혈발생솔:산후출혈발생솔익모초조위32.0%(47/147)、익모초+축궁소조위11.1%(16/144)、축궁소조위18.8%(28/149),익모초+축궁소조산후출혈발생솔최저,이익모초조산후출혈발생솔최고,량조비교,차이유통계학의의(P<0.01).(4)산전급산후혈홍단백、홍세포계수:각조산후여산전비교,홍세포계수화혈홍단백수평균유불동정도적하강,기중익모초조홍세포계수차치위(0.3±0.5)×1012/L,혈홍단백차치위(9±13)g/L;익모초+축궁소조홍세포계수차치위(0.2±0.4)×1012/L,혈홍단백차치위(6±10)g/L;축궁소조홍세포계수차치위(0.2±0.4)×10124/L,혈홍단백차치위(7±30)g/L,축궁소조、익모초+축궁소조분별여익모초조비교,차이균유통계학의의(P<0.05);익모초+축궁소조혈홍단백하강정도최저.(5)불량반응:3조중공유2례발생경도과민반응.결론부궁산술중응용익모초주사액연합축궁소,가명현예방산후출혈적발생,차약물안전성호.
Objective To evaluate the efficacy and safety of motherwort (herbs leonuri/leonurus heterophyllus sweet) injection for preventing postpartum hemorrhage after caesarian section. Methods The prospective study was designed as a randomized and single blind multi-center research matched with positive agent as controls from Apt 2007 to Aug 2007. 440 women underwent caesarian section (CS) indicated by obstetric factors were enrolled from 15 teaching hospitals in China and assigned into three groups: group of motherwort: 147 cases were administered by motherwort 40 rag uterine injection during CS and 20 mg intramuscular injection per 12 hours 3 times after CS; group of motherwort + oxytocin : 144 cases were administered by motherwort 40 mg and oxytocin 10 U uterine injection during CS and motherwort 20 mg intramuscular injection per 12 hours 3 times after CS and group of oxytocin: 149 cases were administered by oxytocin 10 U uterine injection and oxytocin 10 U + 5% glucose 500 nd intravenously injection during operation and oxytocin 10 U intramuscular injection per 12 hours 3 times after CS. The following clinical parameter were collected and analyzed: (1) The amount of blood loss during operation, at 2, 6, 12, 24, 48 hours after operation. (2) The total amount of blood loss in 24 hours after CS and the incidence of postpartum hemorrhage. (3) The change of level of hemoglobin (Hb) and counting of red blood cell ( RBC ) from prepartum to postpartum. (4) Adverse reaction. Results (1) The mean amount of blood loss during operation were (368±258) ml in group of motherwort, (255±114) mi in group of motherwort + oxytocinand (269±141 ) ml in group of oxytocin, which exhibited significant difference among three groups ( P<0.01 ). Meanwhile, no statistical different amount of blood loss among three groups were observed at 2,6,12, 24, 48 hours after CS. (2)The amount of blood loss of postpartum at 24 hours were (480±276)ml ingroup of motherwort, (361±179) ml in group of motherwort + oxytocin, (381±179) nd in group of oxytocin, which showed significant difference among 3 groups(P <0.01 ). (3) The incidence of postpartum hemorrhage were 32.0% (47/147) in group of motherwort, 11.1% (16/144) in group of motherwort + oxytocin, and 18.8% in (28/149) in group of oxytocin. When comparing the lowest rate of postpartum blood loss in group of motherwort + oxytocin and the highest rate in group of motherwort, it displayed statistical difference (P<0.01). (4) The decreased level of RBC and Hb were shown that RBC(0.3±0.5)×10<'12<‘/L and Hb(9±13)g/L in group of motherwort, RBC (0.2±0.4)×10<'12/L and Hb ( 6±10) g/Lin group of motherwort + oxytocin and RBC (0.2±0.4)×10<'12/L and Hb(7±30) g/L in group of oxytocinrespectively. However, the comparison of different value of RBC and lib in group of oxytocin and motherwort +oxytocin showed significant difference (P<0.05 ). (5) Two cases with allery reaction was observed.Conclusion It is safe and efficacious that combined use of motherwort injection and oxytocin was to preventpostpartum hemorrhage during or after caesarian section.
