预防性静脉注射氨甲环酸减少剖宫产术中及术后失血的效果：一项双盲随机对照研究。

Use of Prophylactic Parenteral Tranexamic Acid for Reduction of Blood Loss During and After Caesarean Section: A Double-Blind Randomized Controlled Study.

机构信息

Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria.

Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria, Email:

出版信息

West Afr J Med. 2024 Jul 30;41(7):810-817.

PMID:39356835

Abstract

BACKGROUND

Haemorrhage is a leading cause of maternal mortality. The prophylactic use of tranexamic acid during vaginal delivery or caesarean section has the potential to reduce blood loss and postpartum anaemia.

OBJECTIVE

To determine the effectiveness and safety of tranexamic acid in reducing blood loss during and within twenty-four hours after a caesarean section.

METHODS

This was a randomised controlled study of two hundred and eighty-four (284) pregnant women booked for caesarean section at the University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu, Nigeria. The women were randomised into two groups: the intervention group (n = 142) that received intraoperative tranexamic acid with routine post-delivery oxytocin injection and the control group (n =142) that received placebo with routine post-delivery oxytocin. Blood loss was assessed both intra and post-operatively using a standard technique.

RESULTS

The mean intraoperative blood loss was significantly lower in the intervention group compared to the control group (435.9±34 vs. 918±258.7, P=0.036). Similarly, the postoperative blood loss within twenty-four hours of surgery was significantly less in the intervention compared to the control group (232.71±67.4 vs. 717±317.6, P=0.031). The incidences of postoperative anaemia and blood transfusion intra or postoperatively were also significantly less in the intervention group compared to the control group (33.2% vs. 48.6; RR = 0.623; 95% CI = 0.46-0.84; p = 0.002, and 6.3% vs 24.6%: RR = 0.257; 95%CI = 0.13-0.52; P= < 0.001, respectively). There were no differences in the incidences of maternal and neonatal complications.

CONCLUSION

The use of prophylactic parenteral tranexamic acid significantly reduces blood loss during and after caesarean section. It is therefore recommended in our obstetric practice as it has the potential to reduce the incidence of postpartum anaemia.

摘要

背景

出血是导致产妇死亡的主要原因。在阴道分娩或剖宫产期间预防性使用氨甲环酸有可能减少失血和产后贫血。

目的

确定氨甲环酸在减少剖宫产术中及术后 24 小时内失血的效果和安全性。

方法

这是一项在尼日利亚恩古州伊图库奥扎拉大学教学医院（UNTH）接受剖宫产的 284 名孕妇的随机对照研究。这些妇女被随机分为两组：干预组（n=142）在术中接受氨甲环酸治疗，并常规给予产后催产素注射；对照组（n=142）接受安慰剂治疗，并常规给予产后催产素注射。使用标准技术评估术中及术后的失血量。

结果

与对照组相比，干预组术中平均失血量明显较低（435.9±34 比 918±258.7，P=0.036）。同样，与对照组相比，术后 24 小时内的手术失血明显较少（232.71±67.4 比 717±317.6，P=0.031）。与对照组相比，干预组术后贫血和术中或术后输血的发生率也明显较低（33.2%比 48.6；RR=0.623；95%CI=0.46-0.84；P=0.002，和 6.3%比 24.6%：RR=0.257；95%CI=0.13-0.52；P<0.001）。母婴并发症的发生率无差异。