目的 探究婦康丸聯(lián)合卡前列素氨丁三醇治療產(chǎn)后宮縮乏力性出血的臨床效果與安全性。方法 選取2021年9月—2023年9月在鄭州大學(xué)第五附屬醫(yī)院分娩后出現(xiàn)宮縮乏力性出血的產(chǎn)婦116例，根據(jù)治療方案的差異分成對(duì)照組和治療組，每組各58例。對(duì)照組子宮體注射卡前列素氨丁三醇注射液，首次注射劑量為250 μg，15 min后仍見(jiàn)活動(dòng)性出血?jiǎng)t再次注射250 μg，總劑量控制在2 mg以內(nèi)。治療組額外口服婦康丸，首次9 g，相隔6 h后再服用9 g，此后每日早晚各服9 g。兩組均進(jìn)行為期5 d的治療。觀察兩組患者臨床療效，比較治療前后兩組患者24 h內(nèi)出血量、止血時(shí)間和住院時(shí)間，血清25-羥維生素D[25-(OH) D]、D-二聚體（D-D）和轉(zhuǎn)化生長(zhǎng)因子-β1（TGF-β1）水平，及子宮復(fù)舊情況和不良反應(yīng)情況。結(jié)果 治療后，對(duì)照組和治療組臨床總有效率分別為86.21%、96.55%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療后，治療組產(chǎn)婦24 h內(nèi)出血量、止血時(shí)間及住院時(shí)間均明顯短于對(duì)照組（P＜0.05）。治療后，兩組產(chǎn)婦血清25-(OH)D和TGF-β1水平顯著升高，而血清D-D水平均顯著降低（P＜0.05），且治療組各指標(biāo)改善顯著優(yōu)于對(duì)照組（P＜0.05）。治療后，兩組產(chǎn)婦子宮三徑之和和宮底高度均顯著降低（P＜0.05），且治療組在各指標(biāo)改善上顯著優(yōu)于對(duì)照組（P＜0.05）。治療過(guò)程中，對(duì)照組不良反應(yīng)發(fā)生率為34.48%，明顯高于治療組的17.24%（P＜0.05）。結(jié)論 婦康丸聯(lián)合卡前列腺素氨丁三醇治療產(chǎn)后宮縮乏力性出血療效顯著，不僅能夠顯著改善產(chǎn)婦出血癥狀并縮短住院時(shí)間，同時(shí)還能夠促進(jìn)子宮復(fù)舊和血清學(xué)指標(biāo)的恢復(fù)。

Objective To explore the therapeutic effect and safety of Fukang Pills and carboprost tromethamine in treatment of postpartum uterine atony and hemorrhage. Methods Patients (116 cases) with postpartum uterine atony and hemorrhage in the Fifth Affiliated Hospital of Zhengzhou University from September 2021 to September 2023 were divided into control and treatment group based on different treatments, and each group had 58 cases. Patients in the control group were iv administered with Carboprost Tromethamine Injection within the uterus, the first injection dose was 250 μg, if active bleeding was still seen 15 min later, 250 μg was injected again, the total dose was controlled within 2 mg. Patients in the treatment group were po administered with Fukang Pills on the basis of the control group, the first time was 9 g, followed by 9 g 6 h apart, and then 9 g for twice daily. Patients in two groups were treated for 5 d. After treatment, the clinical evaluations were evaluated, the 24 h bleeding volume, hemostasis time, inpatient duration, serum 25-(OH)D, D-D, and TGF-β1 levels, postpartum uterus regression and adverse reactions in two groups before and after treatment were compared. Results After treatment, the total clinical effective rates of the control group and the treatment group were 86.21% and 96.55%, respectively, and the difference between the two groups was statistically significant (P < 0.05). After treatment, the amount of bleeding in 24 h, hemostasis time, and hospital stay in the treatment group were significantly shorter than those in the control group (P < 0.05). After treatment, the levels of serum 25-(OH)D and TGF-β1 of parturients in both groups were significantly increased, while the level of serum D-D was significantly reduced (P < 0.05). And the levels of these indicators in the treatment group were better than those in the control group (P < 0.05). After treatment, the sum of three uterine diameters and fundal height of parturients in both groups were significantly reduced, and which in the treatment group were significantly lower than those in the control group (P < 0.05). During treatment, the incidence of adverse reactions (34.48%) in the control group was significantly higher than that (17.24%) in the treatment group (P < 0.05). Conclusion The combination of Fukang Pills and carboprostaglandin tromethamine has a significant therapeutic effect on postpartum uterine atony and hemorrhage, which can not only significantly improve the bleeding symptoms of parturients and shorten hospital stay, but also promote uterine involution and the recovery of serological indicators.

R984

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃聯(lián)合共建項(xiàng)目(LHGJ20220567)