目的 探討垂體后葉素聯(lián)合卡前列素氨丁三醇和縮宮素治療胎盤早剝產(chǎn)后大出血中的臨床療效。方法 選擇2015年6月—2018年6月焦作市婦幼保健院56例胎盤早剝產(chǎn)后大出血患者作為研究對象，根據(jù)隨機(jī)動態(tài)原則將患者分為對照組（n=28）和觀察組（n=28）。對照組在胎兒娩出后深部肌肉注射卡前列素氨丁三醇注射液，250 μg/次，同時靜脈滴注縮宮素注射液，10 U/次，對于止血效果不佳者再次給予卡前列素氨丁三醇深部肌肉注射。觀察組在對照組的基礎(chǔ)上將6 U垂體后葉注射液，溶于0.9%氯化鈉溶液20 mL中于子宮肌層局部注射。比較兩組患者第三產(chǎn)程時間、產(chǎn)后出血及止血情況；凝血指標(biāo)變化；住院時間、血紅蛋白水平以及不良事件發(fā)生情況。結(jié)果 治療后，觀察組第三產(chǎn)程時間和止血時間顯著短于對照組，產(chǎn)后15 min、2 h及24 h時的出血量少于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組的D-二聚體（D-D）、活化部分凝血活酶時間（APTT）、血漿凝血酶原時間（PT）、凝血酶時間（TT）均顯著降低，纖維蛋白原（Fbg）水平顯著升高（P<0.05）；治療后，觀察組各凝血指標(biāo)水平優(yōu)于對照組（P<0.05）。與對照組治療后相比，觀察組患者住院時間顯著縮短，血紅蛋白水平顯著升高，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，觀察組不良事件發(fā)生率為10.71%，顯著低于對照組的39.29%，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 垂體后葉素聯(lián)合卡前列素氨丁三醇和縮宮素有助于改善凝血功能，減少產(chǎn)后出血量及不良事件發(fā)生率，縮短住院時間，在胎盤早剝產(chǎn)后大出血治療中具有較高的應(yīng)用價值。

Objective To investigate the clinical effect of pituitrin combined with carboprost tromethamine in treatment of massive hemorrhage after placental abruption. Methods 56 patients with postpartum massive hemorrhage after placental abruption in Jiaozuo City Maternal and Child Health Hospital from June 2015 to June 2018 were selected as research objects. According to the random dynamic principle, subjects were divided into the control group (n=28) and the observation group (n=28). In the control group, after the birth of the fetus, patients were given a deep intramuscular injection of Carboprost Tromethamine Injection, 250 μg/ time, and iv administered with Oxytocin Injection at the same time, 10 U/time. For those with poor hemostatic effect, Carboprost Tromethamine Injection was injected with the deep muscle again. Patients in the observation group were injected Posterior Pituitary Injection into the myometrium on the basis of control group, 6 U was dissolved into 0.9% sodium chloride solution 20 mL. The third stage of labor, postpartum hemorrhage and hemostasis were compared between two groups. And the changes of coagulation index, the length of stay, hemoglobin levels, and adverse events in two groups were compared. Results After treatment, the time of the third stage of labor and hemostasis in the observation group was significantly shorter than those in the control group, and the amount of bleeding at 15 min, 2 h and 24 h were less than those in the control group, the difference between two groups was statistically significant (P<0.05). After treatment, D-D, APTT, PT and TT in two groups were significantly decreased, while Fbg level were significantly increased (P<0.05). After treatment, the coagulation indexes in the observation group were better than those in the control group (P<0.05). Compared with the control group, the length of stay in the observation group was significantly shortened, and the hemoglobin level was significantly increased after treatment, the difference between two groups was statistically significant (P<0.05). After treatment, the incidence of adverse events in the observation group was 10.71%, which was significantly lower than 39.29% in the control group, the difference between two groups was statistically significant (P<0.05). Conclusion Pituitrin combined with carboprost tromethamine helps to improve blood coagulation, reduce postpartum hemorrhage, and the incidence of adverse events, and shorten hospital stay. It has a high application value in treatment of massive hemorrhage after placental abruption.

R984