Abstract:

Objective　To explore the effect of tranexamic acid combined with uterine belt suture technique on the blood loss of patients with postpartum hemorrhage caused by uterine atony. Methods　A prospective study was conducted, and 102 patients with postpartum hemorrhage due to uterine atony who were admitted to Xi'an International Medical Center Hospital from April 2023 to June 2024 were selected.Using the computer-generated random number table method, the subjects were divided into two groups in a 1:1 ratio, with 51 cases in each group.The control group: age 24-35 (30.82±3.06) years old, gestational weeks 36-42 (39.71±1.34) weeks, underwent uterine belt-style suture surgery.The research group: Age 25-37 (31.02±3.24) years old, gestational weeks 37-42 (39.95±1.87) weeks. In addition to the control group, tranexamic acid was added (1 g of tranexamic acid was dissolved in 100 ml of 5% glucose solution and then administered by intravenous drip). The perioperative indicators of the two groups were compared, as well as the coagulation function, blood indicators and immune function before and after treatment. The statistical method employed was the t-test. Results　The postpartum 24-hour bleeding volume, hemostasis time, operation time, and total hospital stay in the research group were all better than those in the control group (all P<0.05).The thrombin time (TT), activated partial thromboplastin time (APTT), and prothrombin time (PT) of the two groups after treatment were all higher than those before treatment, while fibrinogen (FIB) was lower than before treatment (all P<0.05).After treatment, the TT, APTT, and PT in the research group were shorter than those in the control group [(18.39±1.56) s vs. (21.13±1.93) s, (39.90±2.31) s vs. (43.48±2.54) s, and (14.02±1.17) s vs. (16.37±1.44) s], and the FIB was higher (3.54±0.71) g/L vs. (2.81±0.46) g/L, and the differences were all statistically significant (t=-7.885,-7.447,-9.045,and 6.162, all P<0.05).The hemoglobin (Hb) and platelet count (PLT) in the study group after treatment were both higher than those in the control group [(90.36±5.26) g/L vs. (85.74±5.23) g/L, (190.54±15.27)×10⁹/L vs. (178.24±15.12)×10⁹/L], and the differences were statistically significant (t=4.448 and 4.088; both P<0.05).After treatment, the CD3+ level in the study group was higher than that in the control group, and the CD4+/CD8+ ratio was lower (all P<0.05). Conclusion　The combined use of tranexamic acid and uterine belt-style suture technique can reduce the blood loss in patients with postpartum hemorrhage caused by uterine atony, improve the coagulation function, and enhance the blood indicators and immune function.

Key words:

Postpartum hemorrhage, Uterine inertia, Tranexamic acid, Uterine brace suture technique

摘要：

目的　探究氨甲环酸联合子宫背带式缝合术对宫缩乏力性产后出血患者出血量的影响。方法　采取前瞻性研究，选取2023年4月至2024年6月于西安国际医学中心医院收治的102例宫缩乏力性产后出血患者。采用计算机生成的随机数字表法，按1∶1比例分为两组，每组51例。对照组：年龄24～35（30.82±3.06）岁，孕周36～42（39.71±1.34）周，行子宫背带式缝合术。研究组：年龄25～37（31.02±3.24）岁，孕周37～42（39.95±1.87）周，在对照组基础上加用氨甲环酸（取1 g氨甲环酸加入100 ml浓度为5%的葡萄糖溶液中稀释后，进行静脉滴注）。比较两组患者围手术期指标和治疗前后凝血功能、血液指标及免疫功能。统计学方法采用t检验。结果　研究组患者产后24 h出血量、止血时间、手术时间、总住院时间均优于对照组（均P<0.05）。两组患者治疗后的凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）均高于治疗前，纤维蛋白原（FIB）低于治疗前（均P<0.05），而研究组患者的TT、APTT、PT均低于对照组［（18.39±1.56）s比（21.13±1.93）s、（39.90±2.31）s比（43.48±2.54）s、（14.02±1.17）s比（16.37±1.44）s］，FIB高于对照组（3.54±0.71）g/L比（2.81±0.46）g/L，差异均有统计学意义（t=-7.885、-7.447、-9.045、6.162，均P<0.05）。研究组患者治疗后的血红蛋白（Hb）、血小板计数（PLT）均高于对照组［（90.36±5.26）g/L比（85.74±5.23）g/L、（190.54±15.27）×10⁹/L比（178.24±15.12）×10⁹/L］，差异均有统计学意义（t=4.448、4.088，均P<0.05）。治疗后，研究组CD3+高于对照组，CD4+/CD8+低于对照组（均P<0.05）。结论　氨甲环酸与子宫背带式缝合术联合使用能减少宫缩乏力性产后出血患者出血量，改善凝血功能，并提升血液指标及免疫功能。

关键词:

产后出血, 宫缩乏力, 氨甲环酸, 子宫背带式缝合术