卡前列甲酯栓预防产后出血的临床观察

doi:10.3877/cma.j.issn.1673-5250.2013.02.017

目的

探讨卡前列甲酯栓预防产后出血的应用价值及时机。

方法

选择2010年5月至12月于本院住院分娩的产妇200例为研究对象。使用双盲、随机法，将其分为3组，卡前列甲酯栓产前组(产前组，n＝60)、卡前列甲酯栓产后组(产后组，n＝60)和对照组(n＝60)，3组产妇在年龄、孕周、体重等方面比较，差异无统计学意义(P>0.05)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象的知情同意，并与之签署临床研究知情同意书)。产前组于第2产程末胎头已着冠，约1～2个宫缩娩出时经肛门置入1 mg卡前列甲酯栓；产后组于胎儿娩出后立即给予上述相同处理；对照组于胎儿娩出后立即经腹壁子宫体注射20 U缩宫素。比较3组产妇的第3产程持续时间和产后出血量等。

结果

产前组的第3产程时间持续时间明显短于产后组和对照组(P<0.01)，且产后2 h，24 h出血量较另2组明显减少。3组用药前、后，收缩压和舒张压变化比较，差异无统计学意义(P>0.05)。应用卡前列甲酯栓的120例产妇中，共计13例(10.83%)出现不良反应，其中，8例(6.67%)为头痛、轻微恶心；5例(4.17%)为腹泻，均未经特殊处理自行缓解。3组患者中均未发生新生儿窒息。

结论

卡前列甲酯栓在产前应用可有效预防产后出血的发生。

关键词: 产后出血, 卡前列甲酯栓, 预防

Objective

To study the application value and clinical effects of Methyl carprost suppository in the prevention of postpartum bleeding.

Methods

From May to December 2010, a total of 200 full-term pregnant women were included into this study. They were divided into three groups according to prospective randomized point method, antepartum group (n=60), post-partum group (n=60) and control group (n=80). Antepartum group were given anal drugs in 1-2 uterine contractions before childbirth, post-partum group were given the same treatment after fetal childbirth, and control group were given 20 U oxytocin uterine injection after fetal child birth. The bleeding amounts of the third stage labor and postpartum were compared. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of the 2nd Affiliated Hospital of Kunming Medical University. Informed consent was obtained from all participates.

Results

The duration of third stage labor of antepartum group was significantly shorter than that of post-partum group and control group (P<0.01), and postpartum amount of bleeding was much less than that of other two groups. There had no significant difference of blood pressure change among three groups (P>0.05). The incidence rate of side-effect of antepartum group and post- partum group was 10.83% (13/120), including 8 cases with headache, and 5 cases with diarrhea.

Conclusions

Prenatal application of Methyl carprost suppository can effectively prevent the occurrence of postpartum bleeding.

Key words: postpartum bleeding, Methyl carprost suppository, prevention

表1 3组患者一般情况比较(±s)

Table 1 General information of three groups(±s)

组别	n	年龄(岁)	孕周(周)	会阴侧切[n(%)]	新生儿出生体重(g)
产前组	60	26.33±2.33	38.42±2.63	32(53.33)	3210.00±385.14
产后组	60	25.68±1.89^a	39.14±2.51^b	35(58.33)^c	3182.00±408.72^d
对照组	80	26.12±2.56^{e i}	39.63±3.11^{f j}	48(60.00)^{g k}	3196.00±482.01^{h l}
P		>0.05	>0.05	>0.05	>0.05

表1 3组患者一般情况比较(±s)

Table 1 General information of three groups(±s)

组别	n	年龄(岁)	孕周(周)	会阴侧切[n(%)]	新生儿出生体重(g)
产前组	60	26.33±2.33	38.42±2.63	32(53.33)	3210.00±385.14
产后组	60	25.68±1.89^a	39.14±2.51^b	35(58.33)^c	3182.00±408.72^d
对照组	80	26.12±2.56^{e i}	39.63±3.11^{f j}	48(60.00)^{g k}	3196.00±482.01^{h l}
P		>0.05	>0.05	>0.05	>0.05

表2 3组患者的第3产程持续时间及产后出血情况(±s)

Table 2 The duration of third stage of labor and the quantity of postpartum hemorrhage (±s)

组别	n	第3产程持续时间(min)	产后2 h出血量(mL)	产后24 h出血量(mL)	产后出血者[n(%)]
产前组	60	5.17±1.28	182.96±81.30	292.11±66.24	0(0.00)
产后组	60	6.03±2.21^a	197.27±63.15^b	296.45±79.62^c	2(3.33)^d
对照组	80	8.11±2.86^{e i}	251.33±52.17^{f j}	368.21±54.33^{g k}	5(6.25)^{h l}

表2 3组患者的第3产程持续时间及产后出血情况(±s)

Table 2 The duration of third stage of labor and the quantity of postpartum hemorrhage (±s)

组别	n	第3产程持续时间(min)	产后2 h出血量(mL)	产后24 h出血量(mL)	产后出血者[n(%)]
产前组	60	5.17±1.28	182.96±81.30	292.11±66.24	0(0.00)
产后组	60	6.03±2.21^a	197.27±63.15^b	296.45±79.62^c	2(3.33)^d
对照组	80	8.11±2.86^{e i}	251.33±52.17^{f j}	368.21±54.33^{g k}	5(6.25)^{h l}

表3 3组患者的血压变化情况(mm Hg，±s)

Table 3 Change tendency of blood pressure among three groups (mm Hg，±s)

组别	n	用药前		用药后
组别	n	收缩压	舒张压	收缩压	舒张压
产前组	60	110.13± 9.08	78.56±11.24	118.47±6.08	76.44±10.14
产后组	60	109.27±10.02^a	75.41± 6.53^b	112.54± 8.27^c	77.89± 4.36^d
对照组	80	115.47± 6.51^ei	76.04± 8.45^fj	119.27± 7.44^gk	74.42± 8.07^hl

表3 3组患者的血压变化情况(mm Hg，±s)

Table 3 Change tendency of blood pressure among three groups (mm Hg，±s)

组别	n	用药前		用药后
组别	n	收缩压	舒张压	收缩压	舒张压
产前组	60	110.13± 9.08	78.56±11.24	118.47±6.08	76.44±10.14
产后组	60	109.27±10.02^a	75.41± 6.53^b	112.54± 8.27^c	77.89± 4.36^d
对照组	80	115.47± 6.51^ei	76.04± 8.45^fj	119.27± 7.44^gk	74.42± 8.07^hl

[1]	Yue J, ed. Obstetrics and gynecology. 7th ed[M]. People's Medical Publishing House, 2010, 205-208.
[2]	World Health Organization. Maternal mortality in 2000. Estimates developed by WHO, UNICEF and UNFPA[R].Geneva, Switzerland, 2004.
[3]	Zhou ZQ. The observation of 100 cases of medicating postpartum hemorrhage with transamin and oxytocin[J]. Chin J Misdiagn, 2004, 4(5):753.
[4]	Ying H, Wang DF. The ppplication of carboprost in obstetrics[J]. J Pract Obstet Gynecol, 2000, 16(3):123-124.
[5]	Liu CX. Clinical research on prevention of postpartum hemorrhage by methyl carboprost suppositories[J]. Chin J Obstet Gynecol, 1997, 32(1):22.
[6]	Bugnon A, Paniagua AE, Postiglione G, et al. Znduction of labor with misoprostol[J]. Gynecol Obstet Mex, 1994, 62:407-414.
[7]	Fan L. The assay and significance of plasma endothelin, thromboxane, prostaglandin, atrial natriuretic peptide in normal pregnancy and pregnancy-induced hypertension[J]. J Pract Obstet Gynecol, 2000, 16(8):477.
[8]	Wang XT, Liu XM. Prevention for bleeding in caesarean section[J]. J Pract Obstet Gynecol, 2003, 19(7):389.
[9]	Wang NP. The impacts of methyl carboprost suppositories on postpartum hemorrhage in primary uterine atony patients[J]. J Clin Exp Med, 2006, 5(4):378-379.
[10]	Blum J, Winikoff B, Raghavan S, et al. Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women receiving prophylactic oxytocin: A double-blind, randomised, non-inferiority trial[J]. Lancet, 2010, 375(9710):217-223.
[11]	Cui XH, Luo WX, Wu M, et al. The observation of preventing bleeding after caesarean section by sublingual methyl carboprost suppositories and using oxytocin[J]. J Southeast China Natl Defence Med Sci, 2010, 12(3):205-208.
[12]	Su XF, Bai H, Li ZM, et al. Clinical investigation of preventing postpartum hemorrhage by methyl carboprost suppositories[J]. J Mod Med Health, 2005, 15(18):1201-1203.
[13]	Li W, Huang H. Clinical observation of preventing bleeding after caesarean section by methyl carboprost suppositories[J]. J Pract Obstet Gynecol, 2001, 17(3):141.
[14]	Wang HF. How to use oxytocin during parturition[J]. J Pract Obstet Gynecol, 1994, 10(5):298.
[15]	Huang WH. Prevention of postpartum hemorrhage by putting methyl carboprost suppository into vagina and sublingual[J]. J Fudan Univ: Med Sci, 1998, 25(2):137.
[16]	Leng W, Liu JX. Clinical investigation of 108 cases of prevention pregnancy-induced hypertension postpartum hemorrhage by using methyl carboprost suppository[J]. J Pract Obstet Gynecol, 1997, 13(2):88.
[17]	Yu XL. Clinical analysis of 130 cases of prevention postpartum hemorrhage by methyl carboprost suppository[J]. J Pract Obstet Gynecol, 2006, 22(5):344.

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Clinical Observation of Methyl Carprost Suppository in the Prevention of Postpartum Bleeding

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Clinical Observation of Methyl Carprost Suppository in the Prevention of Postpartum Bleeding