不同剂量的氨甲环酸在预防剖宫产产后出血中的效果及其抗纤维蛋白溶解作用分析

叶丽卿

【摘要】 目的：探究不同剂量的氨甲环酸在预防剖宫产产后出血中的效果及其抗纤维蛋白溶解作用。方法：选取2020年11月—2022年11月漳州市長泰区医院剖宫产分娩产妇93例，应用随机数字表法、双盲将其分为对照组、低剂量组、高剂量组，对照组（n=31）应用缩宫素治疗，低剂量组（n=31）胎儿分娩后在对照组基础上将0.5 g氨甲环酸与5%葡萄糖10 mL配伍后滴注，高剂量组（n=31）胎儿分娩后在对照组基础上将1 g氨甲环酸与5%葡萄糖10 mL配伍后滴注，对比三组出血情况（术后2 h、术后24 h出血量、出血率）、凝血功能[血红蛋白（Hb）、红细胞压积（HCT）、血小板计数（PLT）、纤维蛋白原（FIB）]、血液流变学[高切全血黏度、中切全血黏度、低切全血黏度、血浆黏滞度]、纤溶功能[D-二聚体（D-D）、纤维蛋白降解产物（FDP）]、不良反应发生率。结果：高剂量组术后2、24 h出血量均低于低剂量组和对照组（P<0.05）；对照组产后出血率高于低剂量组、高剂量组（P<0.05）。术前，三组Hb、HCT、PLT、FIB水平差异均无统计学意义（P>0.05）；术后24 h，三组Hb、HCT、PLT、FIB水平均降低，高剂量组降幅均低于低剂量组、对照组（P<0.05）。术前、术后24 h三组高切全血黏度、中切全血黏度、低切全血黏度、血浆黏滞度差异均无统计学意义（P>0.05）。术前，三组D-D、FDP水平差异均无统计学意义（P>0.05）；术后24 h，三组D-D、FDP均降低，高剂量组均低于低剂量组、对照组（P<0.05）。三组间不良反应发生率相较差异无统计学意义（P>0.05）。结论：高剂量氨甲环酸在预防剖宫产产后出血中效果显著，可减少术中、术后出血量，对凝血功能影响较小，调节纤溶功能，血液流变学稳定，安全性较高。

【关键词】 不同剂量 氨甲环酸 剖宫产 产后出血 抗纤维蛋白溶解 凝血功能 血液流变学

Analysis of the Effect of Different Doses of Tranexamic Acid in the Prevention of Postpartum Hemorrhage in Cesarean Delivery and Its Antifibrinolytic Effect/YE Liqing. //Medical Innovation of China， 2024， 21（07）： 0-014

[Abstract] Objective： To investigate the effect of different doses of Tranexamic Acid in the prevention of postpartum hemorrhage after cesarean delivery and its antifibrinolytic effect. Method： A total of 93 postpartum women who underwent cesarean section at Changtai District Hospital， Zhangzhou City from November 2020 to November 2022 were selected. They were divided into the control group， the low-dose group， and the high-dose group using double-blind random number table method. The control group （n=31） received treatment with Oxytocin， on this basis， the low-dose group （n=31） was treated with 0.5 g Tranexamic Acid combined with 5% Glucose 10 mL after delivery， and the high-dose group （n=31） was treated with 1 g Tranexamic Acid combined with 5% Glucose 10 mL after delivery. The bleeding conditions （amount of bleeding at 2 hours and 24 hours after surgery， bleeding rate）， coagulation function [hemoglobin （Hb）， hematocrit （HCT）， platelet count （PLT）， fibrinogen （FIB）]， hemorheology [high shear whole blood viscosity， medium shear whole blood viscosity， low shear whole blood viscosity， plasma viscosity]， fibrinolysis function [D-dimer （D-D）， fibrinolytic degradation products （FDP）]， and incidence of adverse reactions were compared. Result： The amount of bleeding in the high-dose group were lower than those in the low-dose group and in the control group at 2 h and 24 h postoperatively （P<0.05）; the postpartum hemorrhage rate in the control group was higher than that in the low-dose group and high-dose group （P<0.05）. Before surgery， the differences of Hb， HCT， PLT and FIB levels in the three groups were not significant （P>0.05）; 24 h postoperatively， the levels of Hb， HCT， PLT and FIB decreased in the three groups， and the decrease in the high-dose group was lower than that in the low-dose group and the control group （P<0.05）. The differences of high cut whole blood viscosity， medium cut whole blood viscosity， low cut whole blood viscosity and plasma viscosity in the three groups before and 24 h after surgery were not significant compared with each other （P>0.05）. Before surgery， there were no statistically significant differences in D-D and FDP levels among the three groups （P>0.05）; 24 hours after surgery， D-D and FDP in all three groups decreased， with the high-dose group being lower than the low-dose group and the control group （P<0.05）. There was no statistically significant difference in the incidence of adverse reactions among the three groups （P>0.05）. Conclusion： High dose Tranexamic Acid has a significant effect in preventing postpartum hemorrhage after cesarean section. It can reduce intraoperative and postoperative bleeding， have minimal impact on coagulation function， regulate fibrinolysis function， stabilize blood rheology， and have high safety.

[Key words] Different doses Tranexamic Acid Cesarean Postpartum hemorrhage Antifibrinolysis Coagulation function Hemorheology

First-author's address： Department of Obstetrics and Gynecology， Changtai District Hospital， Zhangzhou City， Zhangzhou 363900， China

doi：10.3969/j.issn.1674-4985.2024.07.003

剖宮产产后出血是导致产妇死亡的危险因素，临床中选择剖宫产常因巨大儿、多胎妊娠、前置胎盘等因素有关，加大产后出血率[1-2]。产妇产后出血时间通常在术后2 h，短时间内大量出血，给产妇身心带来严重影响。调查……