Abstract:

Objective　To observe the therapeutic effect of carboprost trometamol on dangerous placenta previa and its effect on pregnancy outcomes. Methods　It was a randomized controlled trial. A total of 65 patients with dangerous placenta previa admitted to Tongxu County Hospital of Traditional Chinese Medicine from January 2019 to May 2022 were taken as the research objects. They were divided into a treatment group (33 cases) and a control group (32 cases) by the random number table method. The age of the treatment group was (29.12±0.41) years old, and the gestational age was (36.15±0.27) weeks. The age of the control group was (29.15±0.33) years old, and the gestational age was (36.11±0.32) weeks. Both groups were treated with cesarean section + conventional oxytocin injection + uterine gauze packing, the control group was treated with mifepristone on the basis, and the treatment group was treated with carboprost trometamol on the basis of the above treatment. The hemostasis, uterine arterial hemodynamics, pregnancy outcomes, and adverse drug reactions of the two groups were compared under different treatment schemes. χ² test and independent sample t test were used. Results　After different treatments, the bleeding volumes 3, 6, 9, and 12 hours after operation in the treatment group were lower than those in the control group (all P<0.05). The hemostatic time in the treatment group was shorter than that in the control group [(2.25±0.31) d vs. (4.15±0.27) d] (t=26.317, P<0.001), and the success rate of hemostasis was higher than that in the control group [84.85% (28/33) vs. 68.75% (22/32)] (χ²=7.274, P=0.007). There were no statistically significant differences in the uterine arterial hemodynamic indexes between the two groups before treatment (all P>0.05). After treatment, the pulsation index (PI) of the treatment group was higher than that of the control group [(0.84±0.11) vs. (0.72±0.14)] (t=3.849, P<0.001), the peak systolic flow velocity/diastolic flow velocity (S/D) of the uterine artery was higher than that of the control group [(2.35±0.85) vs. (2.02±0.13)] (t=2.171, P=0.034), and the resistance index (RI) was lower than that of the control group [(0.53±0.12) vs. (0.69±0.41)] (t=2.149, P=0.036). The incidence of adverse pregnancy outcomes in the treatment group was lower than that in the control group [15.15% (5/33) vs. 28.13% (9/32)] (χ²=4.968, P=0.026). The incidence of adverse drug reactions in the treatment group was higher than that in the control group [18.18% (6/33) vs. 15.63% (5/32)], but the difference was not statistically significant (χ²=0.232, P=0.630). Conclusions　In addition to routine hemostatic measures and mifepristone treatment for patients with dangerous placenta previa, the combined application of carboprost trometamol can enhance its hemostatic effect, which has positive significance in improving the uterine arterial hemodynamics and the patients' pregnancy outcomes. Moreover, the combined application of this drug does not significantly increase the risk of adverse drug reactions in patients, with high safety.

Key words:

Dangerous placenta previa, Carboprost trometamol, Hemostatic effect, Pregnancy outcomes, Medication safety

摘要：

目的　观察卡前列素氨丁三醇治疗凶险性前置胎盘的效果及对妊娠结局的影响。方法　本研究为随机对照试验。选取通许县中医院2019年1月至2022年5月期间收治的65例凶险性前置胎盘患者为研究对象，经随机数字表法将其分为治疗组［33例，年龄（29.12±0.41）岁，孕周（36.15±0.27）周］和对照组［32例，年龄（29.15±0.33）岁，孕周（36.11±0.32）周］，两组均予以剖宫产+常规缩宫素注射+宫腔纱条填塞治疗，对照组采用米非司酮配合治疗，治疗组在以上治疗基础上联合应用卡前列素氨丁三醇。比较两组患者在不同治疗方案下的止血情况、子宫动脉血流动力学指标变化情况、妊娠结局以及药物不良反应发生情况。采用χ²检验、独立样本t检验。结果　经不同方案治疗后，治疗组的术后3、6、9、12 h的出血量均低于对照组（均P<0.05）；治疗组的止血时间（2.25±0.31）d短于对照组（4.15±0.27）d（t=26.317，P<0.001），止血成功率84.85%（28/33）高于对照组68.75%（22/32）（χ²=7.274，P=0.007）。两组患者治疗前的子宫动脉血流动力学指标差异均无统计学意义（均P>0.05）；治疗后，治疗组的搏动指数（PI）（0.84±0.11）高于对照组（0.72±0.14）（t=3.849，P<0.001），子宫动脉收缩期峰值流速/舒张期流速（S/D）（2.35±0.85）高于对照组（2.02±0.13）（t=2.171，P=0.034），阻力指数（RI）（0.53±0.12）低于对照组（0.69±0.41）（t=2.149，P=0.036）。治疗组的不良妊娠结局发生率15.15%（5/33）低于对照组28.13%（9/32）（χ²=4.968，P=0.026）。治疗组的药物不良反应发生率18.18%（6/33）略高于对照组15.63%（5/32），但差异无统计学意义（χ²=0.232，P=0.630）。结论　在予以凶险性前置胎盘患者常规止血措施及米非司酮治疗的同时，联合应用卡前列素氨丁三醇可增强其止血效果，对改善子宫动脉血流动力学及患者妊娠结局均有积极意义，且联合应用此药未明显增加患者的药物不良反应发生风险，安全性较高。

关键词:

凶险性前置胎盘, 卡前列素氨丁三醇, 止血效果, 妊娠结局, 用药安全性