目的 探討凝血酶聯(lián)合卡前列素氨丁三醇注射液對宮縮乏力性產(chǎn)后出血患者的止血效果及凝血因子的影響。方法選取2015年1月—2019年12月武安市第一人民醫(yī)院宮縮乏力性產(chǎn)后出血患者130例作為研究對象，根據(jù)治療方案不同分為對照組（n=62）和觀察組（n=68）。對照組自然分娩患者經(jīng)臀部注射卡前列素氨丁三醇注射液250 μg；剖宮產(chǎn)患者經(jīng)宮體注射卡前列素氨丁三醇注射液250 μg。若未達止血目的，于15、30 min后再次給藥，但總劑量<2 mg。觀察組在對照組基礎(chǔ)上增加凝血酶凍干粉宮腔灌注治療，取2 000單位凝血酶＋20 mL生理鹽水，緩慢注進宮腔，再將5 mL生理鹽水注入導(dǎo)管中拔出導(dǎo)管，無菌紗布堵塞宮頸口。側(cè)臥，抬高臀部，4 h后取出宮頸紗布。觀察兩組的止血效果，比較患者治療前、治療后30 min、1 d的凝血因子［凝血因子Ⅶ（F Ⅶ）、F Ⅷ、F Ⅸ］水平、創(chuàng)面閉合能力［內(nèi)皮生長因子（VEGF）、內(nèi)皮生長因子受體-1（VEGFR-1）、內(nèi)皮生長因子受體-2（VEGFR-2）］、并發(fā)癥發(fā)生率、生理功能恢復(fù)情況。結(jié)果 治療后，觀察組子宮持續(xù)收縮時間長于對照組，止血時間、住院時間短于對照組，陰道出血量（產(chǎn)后2 h、產(chǎn)后24 h）、轉(zhuǎn)手術(shù)率低于對照組（P<0.05）。治療后30 min、1 d血漿F Ⅶ、F Ⅷ、F Ⅸ水平均顯著升高（P<0.05），且觀察組F Ⅶ、F Ⅷ、F Ⅸ水平顯著高于同期對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。治療后30 min、治療后1 d血清VEGF、VEGFR-1、VEGFR-2水平均顯著升高（P<0.05），且觀察組血清VEGF、VEGFR-1、VEGFR-2水平顯著高于同期對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，觀察組并發(fā)癥發(fā)生率為7.35%，顯著低于對照組的20.97%（P<0.05）。治療后，觀察組惡露時間、復(fù)潮時間、月經(jīng)周期均短于對照組，第1次月經(jīng)量少于對照組（P<0.05）。結(jié)論 凝血酶聯(lián)合卡前列素氨丁三醇注射液可提高宮縮乏力性產(chǎn)后出血患者止血效果，改善凝血因子水平及創(chuàng)面閉合能力，減少并發(fā)癥的發(fā)生，促進生理機能恢復(fù)。

Objective To investigate the effect of thrombin combined with carboprost tromethamine on hemostasis and coagulation factors in patients with postpartum hemorrhage caused by uterine weakness. Methods A total of 130 patients with postpartum hemorrhage due to uterine weakness in Wuan First People's Hospital from January 2015 to December 2019 were selected as the research subjects, and were divided into control group (n=62) and observation group (n=68) according to different treatment regimens. Patients in the control group were injected 250 μg Carboprost Tromethamine Injection through hip for patients with natural delivery; 250 μg Carboprost Tromethamine Injection was administered to patients undergoing cesarean section in patients with cesarean section under direct vision. If the hemostasis was not achieved, the drug was given again 15 and 30 min later, but the total dose was less than 2 mg. Patients in the observation group were intrauterine perfusion with Lyophilizing Thrombin Powder on the basis of control group, 2 000 units of thrombin + 20 mL of normal saline were slowly injected into the uterine cavity, then 5 mL of normal saline was injected into the catheter to pull out the catheter, and the cervical orifice was blocked with sterile gauze. Lie on the side, raise the buttocks, and take out the cervical gauze 4 h later. The hemostasis effect of two groups was observed, and the levels of coagulation factor (F Ⅶ, F Ⅷ, and F Ⅸ), wound closure ability (VEGF, VEGFR-1, and VEGFR-2), the incidence of complications, and the recovery of physiological function before treatment and 30 min or 1 d after treatment were compared. Results After treatment, the duration of uterine contraction in the observation group was longer than that in the control group, the hemostasis time and hospitalization time were shorter than those in the control group, the amount of vaginal bleeding (2 h postpartum, 24 h postpartum) and the rate of surgical transfer in the observation group were less than those in the control group (P < 0.05). 30 min and 1 d after treatment, the plasma levels of F Ⅶ, F Ⅷ, and F Ⅸ were significantly increased (P < 0.05), and the levels of F Ⅶ, F Ⅷ, and F Ⅸ in the observation group were significantly higher than those in the control group at the same period, the difference being statistically significant (P < 0.05). After treatment of 30 min and 1 d, the levels of serum VEGF, VEGFR-1, and VEGFR-2 were significantly increased (P < 0.05), and the levels of serum VEGF, VEGFR-1 and VEGFR-2 in the observation group were significantly higher than those in the control group at the same period, with statistical significance (P < 0.05). After treatment, the complication rate of the observation group was 7.35%, which was significantly lower than 20.97% of the control group (P < 0.05). After treatment, lochia time, return to tide time, and menstrual cycle in the observation group were shorter than those in the control group, and the first menstrual volume was less than that in the control group (P < 0.05). Conclusion Thrombin combined with carboprost tromethamine can improve the hemostatic effect of postpartum hemorrhage patients with uterine weakness, improve the level of coagulation factors and wound closure ability, reduce the incidence of complications, and promote the recovery of physiological functions.

R984

河北省醫(yī)學(xué)科學(xué)研究重點課題計劃項目（20181714）