目的: 评估子宫按摩法联合缩宫素对预防高危产妇产后出血的有效性和安全性。方法: 采用前瞻性随机对照试验,选取2019年1月至2023年12月在长沙市第三医院产科分娩的400例高危产妇为研究对象,随机分为对照组和观察组,各200例。对照组接受常规缩宫素治疗,观察组在此基础上联合子宫按摩。主要观察指标包括第三产程时长、产后2 h和24 h内的出血量、止血时间,次要观察指标包括产后的凝血功能、产后1 h血红蛋白水平、子宫复旧情况、并发症发生率、住院时长以及患者满意度。结果: 与对照组相比,观察组在第三产程时长[（8.33±2.81）min vs （10.51±3.22）min,P<0.001]、产后2 h内的出血量[（187.45±46.52）mL vs （250.62±52.85）mL,P<0.001]、产后24 h内的出血量[（357.83±80.76）mL vs （455.23±98.42）mL,P<0.001]和止血时间（38.27±8.95）min vs （43.59±10.25）min,P<0.001]等方面均显著优于对照组。此外,观察组的子宫能更快复旧,住院时间更短,患者满意度更高。两组在并发症发生率上无显著差异。结论: 子宫按摩法联合缩宫素在预防高危产妇产后出血方面显著优于单一缩宫素治疗,且安全性良好。这一联合治疗方法在临床实践中具有推广应用的价值。
Abstract
Objective To evaluate the efficacy and safety of uterine massage combined with oxytocin in preventing postpartum hemorrhage (PPH) in high-risk parturients. Methods A prospective randomized controlled trial was conducted, enrolling 400 high-risk parturients who delivered in the obstetrics department of a tertiary hospital between January 2019 and December 2023. The participants were randomly divided into a control group and an observation group, with 200 cases in each group. The control group received routine oxytocin therapy, while the observation group received uterine massage in addition to oxytocin therapy. The primary outcomes measured included the duration of the third stage of labor, blood loss within 2 hours and 24 hours postpartum, and hemostasis time. Secondary outcomes included postpartum coagulation function, hemoglobin levels 1 hour postpartum, uterine involution, complication rates, hospital stay duration, and patient satisfaction. Results Compared with the control group, the observation group showed significant improvements in the duration of the third stage of labor (8.33±2.81 minutes vs 10.51±3.22 minutes, P<0.001), blood loss within 2 hours postpartum (187.45±46.52 mL vs 250.62±52.85 mL, P<0.001), blood loss within 24 hours postpartum (357.83±80.76 mL vs 455.23±98.42 mL, P<0.001), and hemostasis time (38.27±8.95 minutes vs 43.59±10.25 minutes, P<0.001). Additionally, the observation group experienced faster uterine involution, shorter hospital stays, and higher patient satisfaction. There was no significant difference in complication rates between the two groups. Conclusion Uterine massage combined with oxytocin is significantly more effective than oxytocin alone in preventing postpartum hemorrhage in high-risk parturients, with good safety. This combined treatment method has valuable potential for clinical application.
关键词
产后出血 /
子宫按摩 /
缩宫素 /
高危产妇
Key words
postpartum hemorrhage /
uterine massage /
oxytocin /
high-risk parturients
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参考文献
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基金
长沙市科技计划项目“血清HCY及E2与产后抑郁的相关性研究”（kq1907007）;长沙市科技计划项目“血清HCY及E2与产后抑郁的相关性研究”（kq1907007）
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