Effect of tranexamic acid combined with strap hysterorrhaphy on postpartum hemorrhage caused by uterine fatigue
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摘要:目的
探讨宫缩乏力性产后出血患者采用氨甲环酸联合背带式子宫缝合术(B-Lynch)对凝血功能、免疫功能的影响。
方法选取2020年6月—2022年6月106例宫缩乏力性产后出血患者为研究对象，依据随机数字表法分为对照组(53例)与观察组(53例)。对照组采用B-Lynch缝合术治疗，观察组采用氨甲环酸联合B-Lynch缝合术治疗。观察2组手术时间、术中出血量、产后24 h出血量、产后24 h血红蛋白水平、产妇不良结局。比较2组不同时点凝血功能、免疫功能、卵巢功能。
结果与对照组比较，观察组手术时间更短，术中出血量、产后24 h出血量更低，差异有统计学意义(P＜0.05); 产后24 h, 2组血红蛋白水平均低于产前，但观察组高于对照组，差异有统计学意义(P＜0.05); 与对照组比较，观察组产妇不良结局发生率更低，差异有统计学意义(P＜0.05); 产后24 h, 2组凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)均长于产前，纤维蛋白原(FIB)水平均低于产前，差异有统计学意义(P＜0.05); 与对照组比较，观察组TT、APTT、PT更短, FIB更高，差异有统计学意义(P＜0.05); 产后24 h, 2组CD4+低于产前, CD8+高于产前, 但与对照组比较，观察组CD4+更高, CD8+更低, 差异有统计学意义(P＜0.05); 产后42 d, 2组促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平高于产前，收缩末期血流峰值(PSV)、搏动指数(PI)低于产前，差异有统计学意义(P＜0.05), 但与对照组比较，观察组FSH、LH、E2水平更低, PSV、PI更高，差异有统计学意义(P＜0.05); 2组产前和产后42 d时阻力指数(RI)比较，差异无统计学意义(P>0.05)。
结论氨甲环酸联合B-Lynch缝合术能够有效减少宫缩乏力性产后出血患者出血量，改善凝血功能及免疫功能，保护卵巢功能，降低产妇不良结局发生率。
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关键词:
- 宫缩乏力性产后出血 /
- 氨甲环酸 /
- B-Lynch缝合术 /
- 凝血功能 /
- 免疫功能
Abstract:ObjectiveTo investigate the effect of tranexamic acid combined with B-Lynch suture on coagulation function and immune function in patients with uterine atonic postpartum hemorrhage.
MethodsA total of 106 patients with uterine atonic postpartum hemorrhage from June 2020 to June 2022 were selected as study subjects and randomly divided into control group (53 cases) and observation group (53 cases) according to the random number table method. The control group was treated with B-Lynch suture, while the observation group was treated with tranexamic acid combined with B-Lynch suture. The operation time, intraoperative blood loss, 24-hour postpartum blood loss, 24-hour postpartum hemoglobin level, and adverse outcomes of the two groups were observed. The coagulation function, immune function, and ovarian function of the two groups were compared at different time points.
ResultsCompared with the control group, the operation time of the observation group was shorter, and the intraoperative blood loss and 24-hour postpartum blood loss were lower (P < 0.05). At 24 hours postpartum, the hemoglobin levels of both groups were lower than those before childbirth, but the observation group was higher than the control group (P < 0.05). Compared with the control group, the incidence of adverse outcomes in the observation group was lower (P < 0.05). At 24 hours postpartum, the thrombin time (TT), activated partial thromboplastin time (APTT), and prothrombin time (PT) of both groups were longer than those before childbirth, while the fibrinogen (FIB) levels were lower than those before childbirth (P < 0.05). Compared with the control group, TT, APTT, and PT of the observation group were shorter, and the FIB level was higher (P < 0.05). At 24 hours postpartum, the CD4+ levels of both groups were lower than those before childbirth, while the CD8+ levels were higher than those before childbirth(P < 0.05). However, compared with the control group, the CD4+ level of the observation group was higher, and the CD8+ level was lower (P < 0.05). At 42 days postpartum, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) in both groups were higher than those before childbirth, while the peak systolic velocity (PSV) and pulsatility index (PI) were lower than those before childbirth (P < 0.05). However, compared with the control group, the levels of FSH, LH, and E2 in the observation group were lower, while the PSV and PI were higher (P < 0.05). There was no statistically significant difference in the resistance index (RI) between the two groups before childbirth and at 42 days postpartum (P>0.05).
ConclusionThe combination of tranexamic acid and B-Lynch suture can effectively reduce the amount of bleeding in patients with uterine atonic postpartum hemorrhage, improve coagulation function and immune function, protect ovarian function, and reduce the incidence of adverse outcomes in postpartum women.
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表 1 2组临床资料比较(x±s)
临床资料 观察组(n=53) 对照组(n=53) t P 年龄/岁 31.58±2.68 31.72±2.54 0.276 0.783 体质量指数/(kg/m2) 24.94±2.31 25.01±2.24 0.158 0.875 孕周/周 38.86±1.02 38.79±0.98 0.360 0.719 孕次/次 1.62±0.43 1.58±0.41 0.490 0.625 产次/次 0.96±0.39 0.91±0.36 0.686 0.494 收缩压/mmHg 121.54±9.86 122.28±10.46 0.375 0.709 白细胞计数/(×109/L) 8.75±2.67 8.83±2.74 0.152 0.879 血小板计数/(×109/L) 218.53±39.58 221.67±42.19 0.395 0.694 
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表 2 2组围术期指标比较(x±s)
组别 手术时间/min 术中出血量/mL 产后24 h出血量/mL 观察组(n=53) 62.49±6.59* 1 161.39±175.42* 1 278.94±181.36* 对照组(n=53) 74.16±7.24 1 318.36±182.17 1 482.43±196.54 与对照组比较, *P＜0.05。
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表 3 2组产前、产后24 h血红蛋白比较(x±s)
g/L 组别 产前 产后24 h 观察组(n=53) 112.03±11.94 89.63±3.29*# 对照组(n=53) 109.96±12.85 82.64±3.42* 与产前比较, *P＜0.05; 与对照组比较, #P＜0.05。
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表 4 2组凝血功能比较(x±s)
组别 凝血酶时间/s 活化部分凝血活酶时间/s 凝血酶原时间/s 纤维蛋白原/(g/L) 产前 产后24 h 产前 产后24 h 产前 产后24 h 产前 产后24 h 观察组(n=53) 13.89±1.63 16.84±1.52*# 34.75±4.16 40.36±3.12*# 11.72±0.98 13.96±1.03*# 3.62±0.53 2.54±0.52*# 对照组(n=53) 14.05±1.76 18.97±1.71* 35.28±4.35 44.87±3.51* 11.58±1.06 15.68±1.12* 3.57±0.51 2.19±0.40* 与产前比较, *P＜0.05; 与对照组比较, #P＜0.05。
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表 5 2组免疫功能比较(x±s)
% 组别 CD4+ CD8+ 产前 产后24 h 产前 产后24 h 观察组(n=53) 39.12±3.24 34.58±2.73*# 28.52±3.16 31.74±2.32*# 对照组(n=53) 38.83±3.46 31.21±3.08* 28.28±3.42 33.96±2.51* 与产前比较, *P＜0.05; 与对照组比较, #P＜0.05。
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表 6 2组卵巢功能比较(x±s)
指标 时点 观察组(n=53) 对照组(n=53) 促卵泡激素/(mIU/mL) 产前 7.36±2.28 7.24±2.13 产后42 d 9.23±2.54*# 11.07±2.30* 黄体生成素/(mIU/mL) 产前 6.12±2.26 6.07±2.33 产后42 d 7.84±2.39*# 8.91±2.12* 雌二醇/(pg/mL) 产前 63.57±6.72 64.03±7.03 产后42 d 76.98±7.41*# 82.62±7.36* 收缩末期血流峰值/(cm/s) 产前 10.07±1.97 10.14±0.92 产后42 d 9.12±1.53*# 8.26±1.64* 搏动指数 产前 1.24±0.31 1.22±0.34 产后42 d 1.10±0.29*# 0.98±0.25* 阻力指数 产前 0.73±0.21 0.74±0.23 产后42 d 0.76±0.22 0.78±0.24 与产前比较, *P＜0.05; 与对照组比较, #P＜0.05。
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