卡贝缩宫素联合Bakri球囊压迫对宫缩乏力性产后出血患者卵巢功能和凝血功能的影响

目的:探讨卡贝缩宫素、Bakri球囊压迫联合治疗对宫缩乏力性产后出血患者卵巢功能以及凝血功能的影响。方法:选取2017年2月-2021年3月我院接诊治疗的86例宫缩乏力性产后出血患者,以随机数字表法分为对照组、研究组,分别给予Bakri球囊压迫单一治疗及卡贝缩宫素、Bakri球囊压迫联合治疗。检测对比患者的卵巢功能指标包括LH、FSH、E2水平,记录两组患者舒张压(DBP)、收缩压(SBP)、心率、出血量变化和止血起效时间,测定纤维蛋白原(FIB)、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT),对比两组不良反应发生情况。结果:两组患者DBP、SBP及心率变化波动较小,治疗后数据显示差异无统计学意义(P>0.05);两组患者治疗后2 h、24 h出血量减少,且研究组治疗后2 h、24 h出血量及止血起效时间短于对照组(P<0.05);治疗后3 d,两组患者FIB水平降低,PT、APPT水平升高,且研究组FIB水平低于对照组,PT、APPT水平高于对照组(P<0.05);治疗后3 d,两组患者血清E₂水平升高,FSH、LH水平降低,且研究组血清E₂、FSH、LH水平优于对照组(P<0.05);研究组不良反应发生率(8.89%)高于对照组(4.88%),但是未见显著性差异(P>0.05)。结论:卡贝缩宫素联合Bakri球囊压迫可改善宫缩乏力性产后出血的卵巢功能及凝血功能,提升产后止血效果,增强患者子宫收缩能力。     

Ex vivo influence of carbetocin on equine myometrial muscles and comparison with oxytocin

To determine the intercyclic effect of oxytocin and carbetocin on equine myometrial tissue, the effect of the drugs was evaluated through pharmacokinetic and pharmacodynamic studies. The complete pharmacokinetic profile for oxytocin was unknown and had to be established. To do so, 25 IU of oxytocin were administered intravenously to six cycling mares and blood samples were collected before and 2, 4, 8, and 15 min after administration. The half-life of oxytocin was determined to be 5.89 min, the clearance rate 11.67 L/min, mean residence time (MRT) 7.78 min. The effective plasma concentration was estimated to be 0.25 ng/mL. This was similar to the concentration achieved for the organ bath study where the concentration that produced 50% of the maximum effect (EC₅₀) was calculated at 0.45 ng/mL. To determine the intercyclic effect of oxytocin and carbetocin uterine myometrial samples were collected from slaughtered mares in estrus, diestrus, and anestrus. The samples were mounted in organ baths and exposed to four ascending, cumulative doses of oxytocin and carbetocin. Area under the curve and amplitude, maximum response (E_max), and concentration that produced 50% of the maximum effect were studied for each agonist and statistically evaluated. The effect of oxytocin on equine myometrial tissue was higher during diestrus, and surprisingly anestrus, than during estrus, whereas the effect of carbetocin was the same independent of the stage of estrous cycle. A significant difference was found for estrous and anestrous samples when oxytocin was used but not when carbetocin was used.