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目的探讨剖宫产术后晚期产后出血的有效药物保守治疗方法。方法选择2007年4月至2011年12月就诊于阜阳市人民医院产科的10例剖宫产术切口愈合不良致晚期产后出血患者,给予口服戊酸雌二醇4 mg,口服,每天3次;血止后每3天递减1/3量,至2 mg/d维持,21 d停药,后10 d加用口服黄体酮,同时给予抗生素、缩宫素及支持治疗。结果 9例患者1～3 d流血明显减少,3～10 d血止,撤退性出血量多于月经量,保守治疗1周期后痊愈出院,随访3～4个月经周期后患者基本恢复正常,除回乳及胃肠道反应外未见其他明显不良反应。1例患者在用药第2天再次出现大出血行介入治疗无效切除子宫。结论大剂量戊酸雌二醇可使子宫肌细胞增生、变厚,血运增加,可加快子宫切口修复愈合,同时可使子宫收缩力增强及增加子宫平滑肌对缩宫素的敏感性,减少出血,达到治愈的目的,为保守治疗提供实用有效的方法。
Objective To investigate the conservative treatment of late-postpartum hemorrhage after cesarean section. Methods From April 2007 to December 2011, 10 patients with delayed postpartum hemorrhage underwent cesarean section incision in Fuyang People ’s Hospital obstetrics and gynecology were given orally administered estradiol valerate 4 mg orally three times daily. Blood 3 days after declining by 1/3, to 2 mg / d to maintain, 21 d withdrawal, 10 d plus oral administration of progesterone, given antibiotics, oxytocin and supportive treatment. Results The blood flow of 1 ~ 3 days was significantly decreased in 9 patients. Blood was withdrawn 3 ~ 10 days later and the amount of bleeding was more than that of menstrual flow. The patients were discharged after conservative treatment for 1 cycle. After 3 to 4 menstrual cycles, the patients returned to normal, Back to the milk and gastrointestinal reactions no other obvious adverse reactions. One patient had recurrent bleeding on the second day of medication. Interventional therapy was ineffective in removing the uterus. Conclusion High dose of estradiol valerate can make myometrium proliferate, thicken and increase blood supply, which can accelerate the healing of uterine incision and increase uterine contractility and increase the sensitivity of uterine smooth muscle to oxytocin to reduce hemorrhage , To achieve the purpose of cure, to provide a practical and effective method of conservative treatment.