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目的探讨氨甲环酸(TXA)用于减少选择性剖宫产产后出血量的有效性和安全性。方法选取138例选择性剖宫产分娩的产妇,分为TXA组和对照组。剖宫产术前10~30 min,TXA组产妇静脉推注含TXA1.0 g/10 ml的5%葡萄糖溶液20 ml,对照组产妇仅予5%葡萄糖溶液30 ml。比较两组产妇围手术期生命体征、出血量及凝血相关指标以及两组新生儿负性事件发生情况。结果 (1)TXA组产妇术中、术后2 h和术后24 h出血量显著低于对照组(P<0.05);TXA组产后出血(PPH)发生率也显著低于对照组(P<0.05);(2)术后48 h与术前比较,TXA组产妇外周血血红蛋白(Hb)、红细胞压积(HCT)、血小板计数(PLT)和纤维蛋白原(FIB)的降幅明显小于对照组(P<0.05);(3)两组产妇围手术期消化道不良反应和术后血栓发生率比较,差异无统计学意义(P>0.05);两组新生儿窒息和转至重症监护(NICU)治疗率比较,差异无统计学意义(P>0.05)。结论选择性剖宫产术前使用TXA对减少产后出血量具有一定的有效性和安全性。
Objective To investigate the efficacy and safety of tranexamic acid (TXA) for reducing the amount of bleeding after selective caesarean section. Methods 138 cases of selective cesarean delivery of mothers, divided into TXA group and control group. 10 ~ 30 min before cesarean section, the TXA group was given a bolus of 20 ml of 5% glucose solution containing TXA 1.0 g / 10 ml and the control group only 30 ml of 5% glucose solution. Surgical perioperative vital signs, bleeding and coagulation-related indicators and incidence of neonatal negative events were compared between the two groups. Results (1) The amount of bleeding in the TXA group was significantly lower than that in the control group at 2 h and 24 h after operation (P <0.05). The incidence of postpartum hemorrhage (PPH) in TXA group was also significantly lower than that in the control group (P < 0.05). (2) Compared with the preoperative level, the decrease of hemoglobin (Hb), hematocrit (HCT), platelet count (PLT) and fibrinogen (FIB) in the peripheral blood of TXA group was significantly lower than that of the control group (P <0.05). (3) There was no significant difference in adverse reactions of digestive tract and postoperative thrombosis between the two groups during perioperative period (P> 0.05). Neonatal asphyxia and transfer to intensive care (NICU) ) Treatment rate, the difference was not statistically significant (P> 0.05). Conclusion Selective cesarean section before the use of TXA to reduce the amount of postpartum hemorrhage has some effectiveness and safety.