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目的观察米索前列醇、缩宫素鼻喷剂及卡前列甲酯栓对普通足月阴道分娩患者产后出血量的临床疗效及其对雌激素、一氧化氮(NO)及一氧化氮合酶(NOS)的影响。方法收集我院收治的普通足月阴道分娩的患者600例,随机分为A组、B组和C组,每组各200例。A组给予缩宫素鼻喷剂,每喷0.1 mL,每侧鼻孔各2喷,每日2次,B组舌下含化米索前列醇200μg,C组给予卡前列甲酯栓1 mg,塞肛。治疗后,比较3组患者血清中雌二醇(E_2)、NO及NOS水平、出血量,观察3组患者的临床疗效和药物不良反应发生情况。结果治疗后,A组总有效率为76.50%(153/200例),B组为86.00%(172/200例),C组为90.50%(181/200例),C组与A组比较,差异有统计学意义(P<0.05)。治疗后,A、B、C组E_2分别为(14.75±2.09),(17.63±2.15),(21.82±3.09)nmol·L~(-1);NO分别为(107.83±11.21),(92.42±10.17),(79.25±9.89)nmol·L~(-1);NOS分别为(25.64±3.11),(22.56±3.05),(19.63±2.28)nmol·L~(-1)(P<0.05)。A、B、C组2 h内出血量分别为(712.43±40.85),(632.43±42.77),(580.74±37.64)mL;2~24 h出血量分别为(138.92±17.86),(126.94±12.93),(103.85±11.13)mL(P<0.05)。A组药物不良反应有鼻腔刺激反应、鼻出血,药物不良反应发生率为1.50%(3/200例);B组药物不良反应有轻度恶心、呕吐、眩晕,药物不良反应发生率为2.50%(5/200例);C组药物不良反应有腹泻、恶心呕吐,药物不良反应发生率为2.00%(4/200例),差异无统计学意义(P>0.05)。结论与米索前列醇、缩宫素鼻喷剂治疗比较,卡前列甲酯栓能够更显著提高普通足月阴道分娩患者血清E_2水平,降低血清NO、NOS水平,减少出血量,且安全性较高。
Objective To observe the clinical efficacy of misoprostol, oxytocin nasal spray and card top methyl ester suppository on postpartum hemorrhage in normal term vaginal delivery and its effect on estrogen, nitric oxide (NO) and nitric oxide synthase (NOS) impact. Methods Six hundred and sixty patients with common term vaginal delivery admitted in our hospital were randomly divided into A group, B group and C group with 200 cases in each group. Group A was given oxytocin nasal spray, each spray 0.1 mL, each spray on both sides of the nose 2 times a day, B group sublingual misoprostol 200μg, C group given captopril suppository 1 mg, Plug anal. After treatment, the serum estradiol (E_2), NO and NOS levels and the amount of bleeding in the three groups were compared. The clinical efficacy and adverse drug reactions of the three groups were observed. Results After treatment, the total effective rate in group A was 76.50% (153/200 cases), in group B 86.00% (172/200 cases), in group C 90.50% (181/200 cases). In group C, compared with group A, The difference was statistically significant (P <0.05). After treatment, the E_2 in groups A, B and C were (14.75 ± 2.09), (17.63 ± 2.15) and (21.82 ± 3.09) nmol·L -1, respectively, and the values of NO were 107.83 ± 11.21 and 92.42 ± 10.17 and 79.25 ± 9.89 nmol·L -1, respectively; NOS was (25.64 ± 3.11), (22.56 ± 3.05) and (19.63 ± 2.28) nmol·L -1 (P <0.05) . The blood loss in groups A, B and C within two hours were (712.43 ± 40.85), (632.43 ± 42.77) and (580.74 ± 37.64) mL, respectively. The bleeding volume within 2 to 24 hours were (138.92 ± 17.86) and (126.94 ± 12.93) , (103.85 ± 11.13) mL (P <0.05). A group of adverse drug reactions nasal irritation, epistaxis, the incidence of adverse drug reactions was 1.50% (3/200 cases); adverse reactions in group B mild nausea, vomiting, dizziness, the incidence of adverse drug reactions was 2.50% (5/200 cases). Adverse reactions of group C were diarrhea, nausea and vomiting. Adverse drug reaction rate was 2.00% (4/200 cases) in group C, with no significant difference (P> 0.05). Conclusions Compared with misoprostol and oxytocin nasal spray, cardiotaxine suppository can significantly improve serum E_2 level, decrease serum NO and NOS level, and reduce bleeding volume in patients with normal full-term vaginal delivery high.