探讨联合应用氨甲环酸和缩宫素对降低子宫肌瘤剔除术围手术期出血量的有效性和安全性。

选择2008年1月至2010年12月于本院拟行经腹子宫肌瘤剔除术后的患者150例为研究对象。将其按照入院顺序随机纳入A组(n＝50，静脉滴注氨甲环酸＋缩宫素止血治疗)，B组(n＝50，静脉滴注缩宫素止血治疗)和C组(n＝50，静脉滴注氨甲环酸止血治疗)。围手术期止血措施采取双盲法进行，除研究设计者外，受试对象本人与研究实施者对具体措施均不知晓(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书)。对3种子宫肌瘤剔除术围手术期止血效果[术中及术后出血量、术后输血率、术后血红蛋白(Hb)水平]进行统计学分析。

本研究4例受试对象因术中发现子宫肌瘤剔除术困难而改行子宫次全切除术。因此，A，B及C组实际纳入患者分别为49例，48例及49例。3组患者一般临床资料比较，差异无统计学意义(P>0.05)。所有患者对上述围手术期的止血措施均无明显不良反应。A组术中出血量[(257±180) mL]明显低于B组[(490±368) mL]和C组[(538±352) mL]，组间比较，差异有统计学意义(P<0.001)；而B组和C组术中出血量比较，差异无统计学意义(P＝0.513)。3组间术后出血量、术后Hb水平和输血率比较，差异无统计学意义(P>0.05)。

氨甲环酸联合缩宫素可有效降低子宫肌瘤剔除术的术中出血量，并且明显优于二者单独应用。单独使用氨甲环酸或缩宫素对子宫肌瘤剔除术围手术期的止血效果相当。

To investigate the effect and safety of tranexamic acid and oxytocin in perioperative blood loss for women underwent myomectomy.

From January 2008 to December 2010, a total of 150 patients who underwent open surgery of myomectomy were randomly selected into this study. They were divided into 3 groups, group A (n=50) was given tranexamic acid and oxytocin intravenously, group B (n=50) was only given oxytocin intravenously, as well as group C (n=50) was given tranexamic acid only. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Panzhihua Second People's Hospital. Informed consent was obtained from each participate. During the perioperative periods, intra- and post-operative blood loss, postoperative hemoglobin and blood transfusion rate were compared among three groups.

Finally, 146 patients were available to analyze, and 4 were withdrawn for reversions to hysterectomy during operations. The baselines characteristics among 3 groups had no statistical difference (P>0.05). No significant adverse events were observed in all patients. Intra-operative blood loss in group A was significantly lower than that in group B and group C (P<0.001), while intra-operative blood loss in group B and C were comparable. Post-operative blood loss, as well as post-operative hemoglobin and blood transfusion rate had no statistical difference among three groups (P>0.05).

Tranexamic acid combined with oxytocin, rather than the single use, could effectively and safely reduce the bleeding during myomectomy. Moreover, the effectiveness of tranexamic acid and oxytocin in reduction of intraoperative blood loss are comparable.