摘要
目的评价抗血栓治疗相关月经过多(HMB)患者的急性出血治疗和长期月经管理的方法及疗效。方法收集2010年1月至2022年8月北京大学人民医院收治的急性异常子宫出血且有抗血栓治疗的患者共22例,其中位年龄为39岁(26~46岁)。回顾性分析抗血栓治疗相关HMB患者的急性出血治疗和长期月经管理的方法及疗效,并分析长期月经管理前后月经量、血红蛋白(Hb)及生命质量的变化。月经量的评估采用月经失血图法(PBAC)进行评分,生命质量的评估采用HMB多属性生命质量量表(MMAS)进行评分。结果(1)急性出血的治疗:22例抗血栓治疗相关HMB患者中,16例于本院、6例于外院急诊处理出血;本院急诊处理出血的16例患者中,3例因严重出血(Hb在12 h内下降了20~40 g/L)急诊行宫腔球囊填塞止血。22例抗血栓治疗相关HMB患者中,15例(包括2例严重出血患者)急诊行吸宫术或子宫内膜去除术并于术中放置左炔诺孕酮宫内释放系统(LNG-IUS)后出血量明显减少;3例利伐沙班减量后急性出血得到控制,继续观察;2例外院予促性腺激素释放激素激动剂控制急性出血,其中1例暂予周期性输血维持治疗,另1例行子宫全切除术;2例(宫腔内球囊压迫、口服炔诺酮各1例)止血后,口服米非司酮暂时闭经。(2)长期月经管理:22例抗血栓治疗相关HMB患者中,15例放置LNG-IUS,其中12例放置满6个月,放置前与放置后6个月相比月经量明显减少[PBAC评分分别为365.0分(272.5~460.0分)、25.0分(12.5~37.5分);Z=4.593,P<0.001],Hb明显升高[分别为91.5 g/L(71.8~108.2 g/L)、128.5 g/L(121.2~142.5 g/L);Z=4.695,P<0.001],生命质量明显提高[MMAS评分分别为415.0分(327.5~472.5分)、580.0分(570.0~580.0分);Z=-3.062,P=0.002]。3例利伐沙班减量患者的PBAC评分下降了20~35分但仍>100分,自觉生命质量较治疗前无明显变化。2例口服米非司酮暂时闭经患者自觉生命质量明显提高,MMAS评分分别较前升高
Objective To evaluate different methods′efficacy of controlling acute bleeding and managing long-term menstruation in patients with heavy menstrual bleeding(HMB)associated with antithrombotic therapy.Methods The clinical data of 22 cases with HMB associated with antithrombotic therapy admitted to Peking University People′s Hospital from January 2010 to August 2022 were analyzed,aged 39 years old(26-46 years).Changes in menstrual volume,hemoglobin(Hb),and quality of life were collected after control of acute bleeding and long-term menstrual management.Menstrual volume was assessed by pictorial blood assessment chart(PBAC),and quality of life was assessed by menorrhagia multi-attribute scale(MMAS).Results(1)Treatment of acute bleeding:of the 22 cases with HMB associated with antithrombotic therapy,16 cases were treated in our hospital and 6 in other hospital for emergency bleeding;of the 16 cases treated in our hospital,3 underwent emergency intrauterine Foley catheter balloon compression due to severe bleeding(Hb decreased by 20 to 40 g/L within 12 hours).Of the 22 cases with antithrombotic therapy-related HMB,15(including 2 cases with severe bleeding)underwent emergency aspiration or endometrial resection,and intraoperative placement of levonorgestrel-releasing intrauterine system(LNG-IUS)followed by a significant reduction in bleeding volume;3 cases had controlled acute bleeding after rivaroxaban dose reduction and continued observation;2 cases were given gonadotropin-releasing hormone agonists to control acute bleeding in other hospital,of which 1 case was temporarily treated with periodic blood transfusion,and the other one patient underwent total hysterectomy;and 2 cases had temporary amenorrhea with oral mifepristone after intrauterine balloon compression or oral norethindrone.(2)Long-term menstrual management:of the 22 cases with antithrombotic therapy-related HMB,15 had LNG-IUS placement and 12 had LNG-IUS placement for 6 months,and menstrual volume was significantly reduced[PBAC scores were 365.0(272.
作者
姜晓琳
闫昕
苏会娜
刘艳华
韩茹雪
宋字仪
孙晓婉
苏德慧
杨欣
Jiang Xiaolin;Yan Xin;Su Huina;Liu Yanhua;Han Ruxue;Song Ziyi;Sun Xiaowan;Su Dehui;Yang Xin(Department of Obstetrics and Gynecology,Peking University People′s Hospital,Beijing 100044,China;Department of Obstetrics and Gynecology,Taiyuan Eighth People′s Hospital,Taiyuan 030012,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2023年第4期286-292,共7页
Chinese Journal of Obstetrics and Gynecology
关键词
月经过多
子宫出血
左炔诺孕酮
抗凝治疗
抗血小板治疗
Menorrhagia
Uterine hemorrhage
Levonorgestrel
Anticoagulant therapy
Antiplatelet therapy
