米索前列醇辅助治疗剖宫产重度产后出血临床观察.docVIP

米索前列醇辅助治疗剖宫产重度产后出血临床观察摘要 目的 观察米索前列醇治疗剖宫产重度产后出血的临床效果。方法对我院1997年1月～2004年12月分娩的34例重度产后出血进行回顾性分析。所有病例均予以米索前列醇舌下含服，在胎儿娩出吸尽宫腔内羊水后立即给予米索前列醇200μg，每隔4～6小时再含服，总量600μg。观察产后米索前列醇的作用、用药前后血压变化及用药后出现的副作用。结果 32例重度产后出血用药后有效，米索前列醇用药前后血压无显著性差异（P?0.05）。 结论米索前列醇促进子宫收缩作用明显，是一种简单、安全、有效的治疗重度产后出血方法。 关键词：重度产后出血 米索前列醇 剖宫产 AbstractObjective:The aim of this study was to observe the effects of misoprostol in treatment of severe postpartum haemorrhage (severe PPH) in cesarean section. Methods The study consisted of 34 women who developed severe PPH after vaginal delivery and cesarean section over the eight years period January 1997 to December 2004.Severe PPH was defined as blood loss greater than 1000ml or with shock.These 34 cases of severe PPH were kept 200μg misoprostal in mouth when the fetal is given birth and the aminiotic fluid is absorbed from the temple.The total dose of misoprostal used interval 4-6hours is 600μg. The effect of misoprostol treatment of severe PPH,blood pressure change before/after giving misoprostol and side effects were observed. Results 32 cases of severe PPH was effective.The blood pressure change before/after misoprostol intake was not obvious（P?0.05）.Conclusions Misoprostol has the obvious function of promoting the uterine constraction .It is a kind of simple,safe and effective method to treat severe PPH. Key words Severe postpartum haemorrhageMisoprostolCesarean section 产后出血是产科最严重的并发症之一。近年来，剖宫产率不断上升，术中产后出血发病率随之上升，而重度产后出血(severepostpartum haemorrhage,severe PPH)常危及产妇的生命。米索前列醇具有比催产素更强的子宫收缩作用，为探讨一种安全、有效的治疗重度产后出血方法。本文运用米索前列醇辅助治疗剖宫产重度产后出血，报道如下。 1.资料与方法 1.1一般资料 1997年1月～2004年12月，我院分娩总数16740例，剖宫产6234例，占同期分娩总数37.24?；剖宫产产后出血256例，占同期剖宫产总数4.11%。本组重度产后出血34例，占剖宫产产后出血13.28?，年龄26±3.20岁，平均孕周28周，经产妇4例，初产妇28例，有人流史19例，平均1.47次。均无明显心血管疾病、无青光眼及哮喘病史，对前列腺素均无禁忌症。剖宫产术式均为子宫下段剖宫产，运用连续硬膜外麻醉。术后常规使用预防性宫缩剂?催产素?及抗生素。 1.2重度产后出血的诊断[1-2]：根据产妇分娩后发生出血的时间，以产后24小时为界，分为产后出血和晚期产后出血，无论是那一种类型，若出血量达到或超过1000ml或合并休克，即诊断为重度产后出血。 1.3米索前列醇由上海华联制药有限公司生产，每片剂量200μg。于剖宫产术中胎儿娩出后吸尽宫腔内羊水立即给予20