目的 探讨阴道分娩孕妇产前低纤维蛋白原( fibrinogen, Fib)水平与产后出血的相关性,为预测产后出血的发生提供依据。方法 选取石家庄市妇幼保健医院产科门诊2017-01至2019-02按期产检、随访的阴道分娩孕妇450例,产前血浆纤维蛋白原(Fib)>3 g/L的孕妇150例为高Fib组;选取300例为产前血浆Fib≤3 g/L的孕妇,随机分为卡前列素氨丁三醇低Fib组和低Fib组,每组150例;卡前列素氨丁三醇低Fib组待胎肩娩出后给予卡前列素氨丁三醇250 mg肌内注射,高Fib组和低Fib组待胎儿一肩娩出后给予缩宫素20 U肌内注射。观察产后出血情况、同时待胎盘娩出后检测产后Fib水平。结果 低Fib组产后出血15例(10.0%);卡前列素氨丁三醇低Fib组产后出血8例(5.33%);高Fib组产后出血2例(1.33%),三组产后出血发生情况比较,差异有统计学意义(P=0.005);卡前列素氨丁三醇低Fib组较低Fib组产后出血量明显减少[(399.00±158.10)ml vs (512.67±175.49)ml],但仍多于高Fib组(281.00±10.39)ml,三组对比差异有统计学意义 (P=0.000),高Fib组和卡前列素氨丁三醇低Fib组产前、产后Fib水平比较差异无统计学意义;低Fib组产后Fib水平较产前明显降低,差异有统计学意义(P=0.002)。结论 产前低水平Fib使产后出血发生率增高,其原因可能与产后Fib明显降低有关,因此产前低水平Fib可做为发生产后出血的预测指标。
Abstract
Objective To investigate the relationships between low concentrations of fibrinogen plasma before vaginal delivery and postpartum hemorrhage in order to provide evidence for predicting and preventing postpartum hemorrhage. Methods Four hundred and fifty pregnant women were selected randomly between January 2017 and February 2019 at the Department of Obstetrics of our hospital. 150 of them whose fibrinogen concentration was above 3 g/L were assigned to the low fibrinogen group, while the rest were randomly and equally divided into the low carboprost tromethamine group and high fibrinogen group. The low carboprost tromethamine group was given 250 μg carboprost tromethamine injection after delivery of the fetal shoulder,while the other two groups were injected with oxytocin. Postpartum hemorrhage was observed. Fibrinogen concentration was determined upon admission to the labor ward in each group of women and after the placenta was delivered. Results There were 15 cases of postpartum hemorrhage (10.0%) in the low fibrinogen group,8 cases (5.33%) in the low carboprost tromethamine group and 2 cases (1.33%) in the high fibrinogen group. There was statistically significant difference (P=0.005) in postpartum hemorrhage between the three groups. The low fibrinogen group had significantly less postpartum hemorrhage than the low fibrinogen group (399.00±158.10) ml vs (512.67±175.49) ml, compared with (281.00±10.39) ml in the high fibrinogen group. Conclusions Low levels of prenatal fibrinogen can increase the risk of postpartum hemorrhage, possibly because postnatal fibrinogen is significantly lower after delivery, so a low level of prenatal fibrinogen may be considered a predictive index for possible postpartum hemorrhage.
关键词
纤维蛋白原 /
产后出血 /
血浆 /
产前 /
低水平
Key words
fibrinogen /
postpartum hemorrhage /
plasma /
prenatal /
low level
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