目的 探討縮宮素聯(lián)合前列腺素類藥物預防高危妊娠且行剖宮產(chǎn)產(chǎn)后出血的臨床療效。方法 選取2012年1月-2013年12月延安大學附屬醫(yī)院產(chǎn)科住院的高危妊娠且行剖宮產(chǎn)產(chǎn)婦330例，按隨機對照原則分為3組，卡前列素氨丁三醇聯(lián)合縮宮素組、卡前列甲酯栓聯(lián)合縮宮素組和縮宮素組，各110例?？ㄇ傲兴匕倍∪悸?lián)合縮宮素組：胎兒娩出后立即宮體肌內(nèi)注射卡前列素氨丁三醇250 μg，及靜脈滴注縮宮素10 U；卡前列甲酯栓聯(lián)合縮宮素組：胎兒娩出后立即舌下含化卡前列甲酯栓1 mg，及靜脈滴注縮宮素10 U；縮宮素組：胎兒娩出后立即靜脈滴注縮宮素10 U，以及宮體肌內(nèi)注射縮宮素10 U。比較3組術中及術后2 h、2～24 h的出血量；觀察3組產(chǎn)后出血、輸血及附加止血措施情況；觀察3組用藥后的副反應。結果 術中、術后2 h、2～24 h，卡前列素氨丁三醇聯(lián)合縮宮素組比卡前列甲酯栓聯(lián)合縮宮素組、縮宮素組出血量均減少，差異有統(tǒng)計學意義（P<0.05）；卡前列甲酯栓聯(lián)合縮宮素組與縮宮素組術中、術后2 h相比出血量減少，差異有統(tǒng)計學意義（P<0.05），而與術后2～24 h出血量相比，差異無統(tǒng)計學意義。卡前列素氨丁三醇聯(lián)合縮宮素組與卡前列甲酯栓聯(lián)合縮宮素組產(chǎn)后出血率、輸血率及附加止血措施干預率均低于縮宮素組，差異均有統(tǒng)計學意義（P<0.05）。3組的副反應率分別為9.09%、8.18%和6.36%，比較無統(tǒng)計學意義。結論 應用卡前列素氨丁三醇聯(lián)合縮宮素可有效預防高危妊娠產(chǎn)后出血，卡前列甲酯栓聯(lián)合縮宮素亦可達到一定的預防療效，而單純應用縮宮素療效欠佳。

Objective To investigate the clinical efficacy of oxytocin combined with prostaglandins in the prevention of postpartum hemorrhage of high-risk pregnancy puerperae with caesarean section. Methods High-risk pregnancy puerperae (330 cases) with caesarean section in Affiliated Hospital of Yan'an University from January 2012 to December 2013 were randomly divided into 3 groups (110 cases in each group). They were carboprost tromethamine combined with oxytocin (CTO) group, carboprost methylate combined with oxytocin (CMO) group, and oxytocin group. And patients in the CTO group were im given carboprost tromethamine 250 μg in the body of uterus following fetus expulsion, and then were iv oxytocin 10 U. The patients in the CMO group were sublingual administered with carboprost methylate 1 mg following fetus expulsion, and were iv oxytocin 10 U. The patients in the oxytocin group were iv oxytocin 10 U following fetus expulsion, and were im given oxytocin 10 U in body of uterus. The quantity of bleedingwas compared among the three groups during the operation, 2, and 2-4 h afteroperation. Thepostpartum hemorrhage, blood transfusion, and additional hemostatic measures after delivery were observed among the three groups. The side reaction was also observed among the three groups.Results During operation, 2, and 2-4 h afteroperation, the quantity of bleeding of maternal in the CTO group was less than that in the CMO group and oxytocin group, with the significant difference (P < 0.05). During the operation, 2 h afteroperation,the quantity of bleeding of maternal in the CMO group was significantly less than that in the oxytocin group (P < 0.05). While 2-4 h afterthe operation, there was no significant difference. The postpartum hemorrhage, blood transfusion rate, and additional intervention measures to stop bleeding in the CTO and CMO groups were significantly lower than those in the oxytocin group (P < 0.05). The side effects of the three groups were 9.09%, 8.18%, and 6.36%, respectively, and there was no significant difference. Conclusion CTO is effective in preventing postpartum hemorrhage of high-risk pregnancy. CMO could reach a certain preventive effect, but the application of oxytocin simply is poor efficacy.

國家自然科學基金資助項目（30973055）