双侧子宫动脉上行支结扎联合米索前列醇在产后出血患者中的应用及对凝血因子的影响

双侧子宫动脉上行支结扎联合米索前列醇在产后出血患者中的应用

及对凝血因子的影响

目的探討双侧子宫动脉上行支结扎联合米索前列醇在产后出血患者中的应用及对凝血因子的影响。方法选取2015年10月～2016年10月我院收治的68例产后出血患者作为研究对象，采用随机数字表法将其分为两组，每组各34例。对照组患者实施B-Lynch缝合术治疗，观察组患者实施双侧子宫动脉上行支结扎联合米索前列醇治疗，于治疗前后行凝血因子检测，比较两组患者的止血效果、术后恢复情况及并发症发生情况。结果观察组患者的止血成功率高于对照组，出血量、输血量少于对照组，手术时间、住院时间短于对照组，差异均有统计学意义（P＜0.05）。观察组患者的恶露暴露时间、产后月经周期短于对照组，月经复潮时间早于对照组，差异有统计学意义（P＜0.05）。治疗后，两组患者的Ang Ⅱ、凝血因子Ⅷ、凝血因子Ⅸ水平高于本组治疗前，差异有统计学意义（P＜0.05）。观察组患者治疗后的AngⅡ、凝血因子Ⅷ、凝血因子Ⅸ水平高于对照组，差异有统计学意义（P＜0.05）。观察组患者的并发症总发生率低于对照组，差异有统计学意义（P＜0.05）。结论双侧子宫动脉上行支结扎联合米索前列醇在产后出血患者中的应用效果显著，可明显改善凝血因子状况，有助于控制出血病情。

[Abstract]Objective To investigate the application of bilateral ascending uterine artery ligation combined with Misoprostol in patients with postpartum hemorrhage and its effect on coagulation factor.Methods 68 patients with postpartum hemorrhage treated in our hospital from October 2015 to October 2016 were selected as subjects and were divided into two groups by random number table method，34 cases in each group.The patients of control group were treated with B-Lynch suture，while the patients of observation group were treated with bilateral ascending uterine artery ligation combined with Misoprostol.Coagulation factor were detected before and after the treatment.Hemostatic effect，postoperative recovery and complications were compared between two groups.Results The success rate of hemostasis in the observation group was higher than that in the control group，the amount of bleeding and blood transfusion were less than those in the control group，the operation time and the length of hospital stay were shorter than those in the control group，and the differences were statistically significant （P＜0.05）.The lochia exposure time and postpartum menstrual cycle of patients in the observation group was shorter than those in the control group，menstruation after tide time was earlier than that in the control group，the differences were statistically significant （P＜0.05）.After treatment，the levels of Ang Ⅱ，clotting factor Ⅷand clotting factor Ⅸof patients in two groups were higher than before the treatment，the differences were statistically significant （P＜0.05）.After treatment，the levels of Ang Ⅱ，clotting factor Ⅷand clotting factor Ⅸof patients in observation group were higher than those in the control group，and the differences were statistically significant （P＜0.05）.The total incidence of complications in the observation group was lower than that in the control group，and the difference was statistically significant （P＜0.05）.Conclusion The

application of bilateral uterine artery ligation combined with Misoprostol in patients with postpartum hemorrhage is significant effect，which can significantly improve coagulation factor status and help to control bleeding.[Key words]Misoprostol；Postpartum hemorrhage；Coagulation factor；Influence

产后出血是临床产科的一种常见并发症，具有病情凶险、进展快、危险度高等特点，如果不能给予患者及时有效的临床治疗，病情将进一步进展，并引发多种严重并发症，进而危及患者的生命[1-2]。目前，临床主要采用B-Lynch缝合术、双侧子宫动脉上行支结扎等手术方式治疗，但手术疗效不一[3-4]，选用何种手术方式治疗产后出血，并确保安全性，便成为了临床医生关注的热点问题。米索前列醇是临床用于预防产后出血的常用药物之一，效果显著[5-6]。本研究选取我院收治的68例产后出血患者作为研究对象，探讨双侧子宫动脉上行支结扎联合米索前列醇在产后出血患者中的应用效果及其对凝血因子的影响，现报道如下。

1资料与方法

1.1一般资料

选取2015年10月～2016年10月我院收治的68例产后出血患者作为研究对象，纳入标准：符合产后出血的临床标准[7]，均行剖宫产手术，产后出血量>500 ml，年龄20～38岁。本研究经我院医学伦理委员会审核及同意，患者均知晓本研究情况并签署知情同意书。排除标准：患有严重器质性疾病的患者及研究资料不全者。采用随机数字表法将其分为两组，每组各34例。对照组患者年龄21～36岁，平均（27.9±3.2）岁；孕龄36～41周，平均（38.2±1.1）周；其中经产妇10例，初产妇24例。观察组患者年龄20～38岁，平均（27.6±2.9）岁；孕龄36～41周，平均（38.4±1.0）周；其中经产妇11例，初产妇23例。两组患者的年龄、孕龄、经产情况等一般资料比较，差异无统计学意义（P>0.05），具有可比性。

1.2方法

对照组患者采用B-Lynch缝合术进行治疗，术中需要将患者子宫移出腹腔，并有效清除宫腔积血，用可吸收线进行垂直进针，通过宫腔，穿进子宫前壁，并穿出，向宮底方向垂直缝合，直到肌层，绕过宫底，直达子宫后壁，由宫体中部向宫颈方向缝合，直到宫腔，于水平方向出针，直到子宫后壁切口，向下并向内挤压宫体，将缝线拉紧并打结。

观察组患者实施双侧子宫动脉上行支结扎联合米索前列醇（北京紫竹药业有限公司，国药准字H20000668）治疗，在胎儿娩出后，立即通过直肠给予患者米索前列醇400 μg。手术操作如下：在剖宫产切口处，将子宫拖出，手握子宫向一侧牵拉，避开圆韧带，要充分暴露患者的手术视野，在缝合可吸收线时，要避免损伤肠管，触摸子宫动脉上行支，用圆针从前向后穿过子宫肌层，从后向前穿过子宫侧缘动静脉丛无血管区后打结。

1.3观察指标