Fletcher H, Frederick J, Hardie M, Simeon D
Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston, Jamaica.
Obstet Gynecol. 1996 Jun;87(6):1014-8. doi: 10.1016/0029-7844(96)00071-3.
To assess the comparative efficacy of perivascular vasopressin and tourniquet in minimizing bleeding and its sequelae at myomectomy.
Between March 1994 and February 1995, 52 women with symptomatic uterine leiomyomas scheduled for myomectomy were entered into a randomized trial comparing vasopressin (26 patients) and tourniquet (26 patients) for hemostasis. Myomectomy was performed after either the perivascular injection of 20 U of vasopressin diluted to 20 mL with normal saline or with the use of a Foley catheter tourniquet around both uterine vessels. The efficacy of each method was measured by comparing differences in pre- and postoperative hemoglobin levels, intraoperative blood pressure, measured blood loss, need for blood transfusion, evidence of postoperative febrile morbidity, complications, and length of hospital stay.
Vasopressin resulted in less blood loss (mean 287.3 mL [standard deviation (SD) 195] versus 512.7 mL [SD 400] for tourniquet [P = .036]). Six of 26 patients in the tourniquet group lost more than 1000 mL of blood, whereas all of the vasopressin subjects lost less than this amount (P = .023). However, there were no significant differences between the two groups in the fall in the hemoglobin level, number of blood transfusions given, intraoperative blood pressure, highest postoperative pulse and temperature, or other complications.
Vasopressin prevents blood loss better than using the tourniquet during myomectomy.
评估血管加压素和止血带在子宫肌瘤切除术中减少出血及其后遗症方面的相对疗效。
1994年3月至1995年2月，52例计划行子宫肌瘤切除术的有症状子宫平滑肌瘤女性患者进入一项随机试验，比较血管加压素（26例患者）和止血带（26例患者）的止血效果。在血管周围注射用生理盐水稀释至20 mL的20 U血管加压素或使用Foley导管止血带环绕双侧子宫血管后进行子宫肌瘤切除术。通过比较术前和术后血红蛋白水平、术中血压、测量的失血量、输血需求、术后发热发病率证据、并发症及住院时间的差异来衡量每种方法的疗效。
血管加压素导致的失血量较少（血管加压素组平均287.3 mL [标准差（SD）195]，止血带组为512.7 mL [SD 400] [P = .036]）。止血带组26例患者中有6例失血量超过1000 mL，而所有血管加压素组患者失血量均少于此量（P = .023）。然而，两组在血红蛋白水平下降、输血次数、术中血压、术后最高脉搏和体温或其他并发症方面无显著差异。
在子宫肌瘤切除术中，血管加压素比使用止血带能更好地防止失血。
