剖宫产术后应用透明质酸对产妇炎性因子及宫腔粘连发生的影响(1)
[摘要] 目的 分析透明质酸对剖宫产孕妇术后炎性因子及宫腔粘连发生的影响。 方法 选取2016年5月～2017年5月海口市第三人民医院妇产科收治的90例剖宫产孕妇，采取随机数字表法分为对照组与观察组，每组各45例。对照组未进行特殊处理，观察组在剖宫产术后使用透明质酸。比较两组产妇治疗后粘连发生率、炎性因子水平[白介素(IL)-6、IL-10、肿瘤坏死因子(TNF-α)]及疼痛程度变化。 结果 观察组产后粘连总发生率低于对照组，差异有统计学意义(P < 0.05)。两组产妇术后3 d与术前比较血清IL-6、IL-10水平及疼痛评分均明显升高，术后7 d与术前3 d比较上述指标水平有所降低，但仍高于术前，差异均有统计学意义(P < 0.05)；术后3、7 d观察组血清IL-6、IL-10、TNF-α水平及疼痛评分均低于对照组，差异均有统计学意义(P < 0.05)。 结论 在剖宫产术中使用透明质酸能够有效地预防粘连发生、改善术后炎性因子水平、降低疼痛程度，值得临床推广使用。
[关键词] 透明质酸；剖宫产；孕妇；炎性因子；宫腔粘连
[中图分类号] R719.8 [文献标识码] A [文章编号] 1673-7210(2018)08(c)-0000-04
[Abstract] Objective To analyze the effect of hyaluronic acid on maternal inflammatory factors and intrauterine adhesions after obstetric cesarean section. Methods A total of 90 pregnant women with cesarean section form May 2016 to May 2017 in Department of Gynaecology and Obstetrics of Haikou Third People′s Hospital were selected and divided into the control group and observation group by random number table method， with 45 cases in each group. Pregnant women in observation group were given the treatment of medical hyaluronic acid after cesarean section， while the control group without any therapy after cesarean section. The incidences of intrauterine adhesion， inflammatory factor levels and pain degree were compared between the two groups. Results The total incidence of postpartum adhesion in observation group was lower than control group， and the difference was significant (P < 0.05). The levels of serum IL-6， IL-10 and pain degree of two groups 3 d after treatment were all higher than those before treatment， the levels of the above indexes， were significantly reduced 7 d after treatment， while those were still higher than those before treatment， and the differences were significant (P < 0.05). The L-6， IL-10， TNF-α and pain degree of the observation group 3 and 7 d after treatment were obviously lower than those of the control group， and the differences were significant (P < 0.05). Conclusion The application of hyaluronic acid can effectively prevent adhesion， improve postoperative inflammatory factors， and relieve pain for pregnant women after cesarean， it is worthy of clinical application.
[Key words] Hyaluronic acid； Cesarean section； Pregnant women； Inflammatory factors； Intrauterine adhesions
宮腔粘连是在临床上被称之为Asheman综合征，常因各种因素如手术操作[1]、感染及放射等引起子宫内膜基底层损伤[2]而导致腔壁粘连，通常也是剖宫产和人流术后的并发症[1-2]。剖宫产手术已成为临床常用的生产方式，是解决难产和妊娠并发症的有效方式，但目前高剖宫产率一直是我国产科的突出问题，尤其是自2016年“二孩政策”放开以来，高危妊娠、瘢痕子宫、双胎多胎等高危产妇持续升高，剖宫产率居高不下。剖宫产为高危产妇提供了便利的同时，也存在一些负面影响，绝大多数产妇术后存在着不同程度的切口疼痛情况，同时伴随炎性因子水平升高，不利于产妇术后恢复[3-4]。另外，产妇在接受剖宫产术后容易出现宫腔粘连等并发症，加重腹部以及伤口的疼痛感，并可引发产妇盆腔疼痛及牵涉疼痛明显增加，不仅影响到了产妇的正常休息，严重者会出现产后后遗症，因此如何解决这些问题对于产后恢复至关重要[5-6]。对于改善术后并发症的相关研究也一直呈现较高趋势，多集中在采用手术或者药物去控制粘连，目前这种做法引起一定的争议，有研究表明药物控制对产后粘连的预防效果并不突出，且手术操作去除粘连的复发率较高。透明质酸作为外科临床中常用的防粘连产品，不仅能够起到调节纤溶蛋白平衡的作用，同时还能够有效地促进创伤愈合[7]，有研究表明其能有效缓解术后粘连的发生[8-9]，因此现就海口市第三人民医院(以下简称“我院”)在常规剖宫产的基础上联合使用医用透明质酸钠凝胶，探究对剖宫产孕妇的术后炎性因子及宫腔粘连发生的影响，结果报道如下：, http://www.100md.com(刘洁玲 梁媛)
[关键词] 透明质酸；剖宫产；孕妇；炎性因子；宫腔粘连
[中图分类号] R719.8 [文献标识码] A [文章编号] 1673-7210(2018)08(c)-0000-04
[Abstract] Objective To analyze the effect of hyaluronic acid on maternal inflammatory factors and intrauterine adhesions after obstetric cesarean section. Methods A total of 90 pregnant women with cesarean section form May 2016 to May 2017 in Department of Gynaecology and Obstetrics of Haikou Third People′s Hospital were selected and divided into the control group and observation group by random number table method， with 45 cases in each group. Pregnant women in observation group were given the treatment of medical hyaluronic acid after cesarean section， while the control group without any therapy after cesarean section. The incidences of intrauterine adhesion， inflammatory factor levels and pain degree were compared between the two groups. Results The total incidence of postpartum adhesion in observation group was lower than control group， and the difference was significant (P < 0.05). The levels of serum IL-6， IL-10 and pain degree of two groups 3 d after treatment were all higher than those before treatment， the levels of the above indexes， were significantly reduced 7 d after treatment， while those were still higher than those before treatment， and the differences were significant (P < 0.05). The L-6， IL-10， TNF-α and pain degree of the observation group 3 and 7 d after treatment were obviously lower than those of the control group， and the differences were significant (P < 0.05). Conclusion The application of hyaluronic acid can effectively prevent adhesion， improve postoperative inflammatory factors， and relieve pain for pregnant women after cesarean， it is worthy of clinical application.
[Key words] Hyaluronic acid； Cesarean section； Pregnant women； Inflammatory factors； Intrauterine adhesions
宮腔粘连是在临床上被称之为Asheman综合征，常因各种因素如手术操作[1]、感染及放射等引起子宫内膜基底层损伤[2]而导致腔壁粘连，通常也是剖宫产和人流术后的并发症[1-2]。剖宫产手术已成为临床常用的生产方式，是解决难产和妊娠并发症的有效方式，但目前高剖宫产率一直是我国产科的突出问题，尤其是自2016年“二孩政策”放开以来，高危妊娠、瘢痕子宫、双胎多胎等高危产妇持续升高，剖宫产率居高不下。剖宫产为高危产妇提供了便利的同时，也存在一些负面影响，绝大多数产妇术后存在着不同程度的切口疼痛情况，同时伴随炎性因子水平升高，不利于产妇术后恢复[3-4]。另外，产妇在接受剖宫产术后容易出现宫腔粘连等并发症，加重腹部以及伤口的疼痛感，并可引发产妇盆腔疼痛及牵涉疼痛明显增加，不仅影响到了产妇的正常休息，严重者会出现产后后遗症，因此如何解决这些问题对于产后恢复至关重要[5-6]。对于改善术后并发症的相关研究也一直呈现较高趋势，多集中在采用手术或者药物去控制粘连，目前这种做法引起一定的争议，有研究表明药物控制对产后粘连的预防效果并不突出，且手术操作去除粘连的复发率较高。透明质酸作为外科临床中常用的防粘连产品，不仅能够起到调节纤溶蛋白平衡的作用，同时还能够有效地促进创伤愈合[7]，有研究表明其能有效缓解术后粘连的发生[8-9]，因此现就海口市第三人民医院(以下简称“我院”)在常规剖宫产的基础上联合使用医用透明质酸钠凝胶，探究对剖宫产孕妇的术后炎性因子及宫腔粘连发生的影响，结果报道如下：, http://www.100md.com(刘洁玲 梁媛)