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目的探讨卡前列素氨丁三醇在中央性前置胎盘剖宫产术中的应用时机。方法选择2013年1月-2014年12月河南省人民医院妇产科收治的有剖宫产指征且术中诊断为中央型前置胎盘的64例产妇,按入组顺序根据随机数字表法将64例患者分为观察组和对照组,每组各32例。观察组于胎儿娩出后立即给予卡前列素氨丁三醇治疗,对照组则在胎盘娩出后给予。比较胎盘自娩数、人工剥离胎盘数、手术时间、术中出血量等。结果观察组患者术中出血量、术后2 h出血量均显著少于对照组(P<0.01)。但两组患者术后24 h内出血量比较,差异无统计学意义(P>0.05)。观察组患者胎盘自娩率显著高于对照组,而人工剥离胎盘率显著低于对照组(P<0.01)。观察组的手术时间显著短于对照组(P<0.01)。观察组6例患者给予宫腔纱条填塞,对照组14例患者给予宫腔纱条填塞,两者比较,差异有统计学意义(P<0.01)。观察组术中及术后输血率为15.6%,对照组为37.5%,两组比较,差异有统计学意义(P<0.01)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论在中央型前置胎盘剖宫产术中胎儿娩出后立即给予卡前列素氨丁三醇宫体注射,可迅速促进子宫下段收缩,提高胎盘自娩率,减少术中出血量,缩短手术时间,且不良反应少,但因价格昂贵,可作为产科急救用药或高危产妇的预防性用药。
Objective To investigate the timing of the application of cardiotensin trometamol in central placenta previa. Methods From January 2013 to December 2014, 64 maternal women with indications for cesarean section and central placenta previa were admitted to Department of Obstetrics and Gynecology, Henan Provincial People’s Hospital. According to the random number table 64 patients were divided into observation group and control group, 32 cases in each group. The observation group was treated with carboprost trometamol immediately after the fetus was delivered, while the control group was given after the placenta was delivered. Comparison of placenta from childbirth, artificial dissection of the placenta number, operation time, intraoperative blood loss and so on. Results The intraoperative blood loss and the amount of hemorrhage 2 h after operation in observation group were significantly less than those in control group (P <0.01). However, there was no significant difference in bleeding volume between the two groups within 24 hours after operation (P> 0.05). The rate of placenta delivery in the observation group was significantly higher than that in the control group, while the rate of manual dissection was significantly lower than that in the control group (P <0.01). The operation time of the observation group was significantly shorter than that of the control group (P <0.01). In the observation group, 6 patients were treated with uterine gauze packing, while in the control group, 14 patients were treated with uterine gauze packing. There was significant difference between the two groups (P <0.01). The intraoperative and postoperative blood transfusion rate was 15.6% in the observation group and 37.5% in the control group. There was significant difference between the two groups (P <0.01). The incidence of adverse reactions in the two groups, the difference was not statistically significant (P> 0.05). Conclusion In the case of central placenta previa, the fetus is injected with carboprost tromethamine immediately after its delivery, which can rapidly promote the contraction of the lower uterine segment, increase the delivery rate of the placenta, reduce the intraoperative blood loss and shorten the operation time , And less adverse reactions, but because of expensive, can be used as emergency obstetric medicine or high-risk maternal prophylaxis.