TAP CHi NGHIEN CU'U Y HpC
SO SANH HIEU QUA CO H 6 | TLf CUNG VA ANH H y ^ N G TIM MACH CUA CARBETOCIN VA OXYTOCIN TRONG M 6 L A Y THAI
N g u y i n Toan Thang'''^, N g u y i n Tho Tru'dng^, Tran Thj Kiem^
' Trw&ng Dai hoc Y Ha Noi, ^ Benh vien Bach Mai
^ Benh vien Da khoa Tuyen Quang Nghien cu'u-ngiu nhien, mu kep tien hanh tren 80 san phu nhim so sanh hieu qua co hoi tCr cung va thay ddi huyet ddng cua 100 meg carbetocin va 10 iU oxytocin tiem tTnh mach cham trong md lay thai Kit qua cho thiy ti le co hdi tw cung tu- trung binh tra len trong va sau md 6 gia d nhdm san phu dung oxytocin va carbetocin twang ung la 85% vs 97,5% va 92,5% vs 97,5% (p > 0,05), ti le cin bd sung tSng co trong 6 gio dau cao han khi dung oxytocin. Khong cd khac biet vi chi s6 cdng thuc mau trong cung nhom va giwa hai nhdm a thai diem rwac va sau md 24 gia. Dung 10 IU oxytocin gay tang tan sd tim va giam huyit ap cd y nghia so vdi dung carbetocin a 30 giay, 1 va 2 phut dau sau diing thudc (p < 0,05) Dung 100 meg car- betocin cd hieu qua co hoi tw cung twang dwang 10 IU oxytocin, tuy nhien nhu eau dung them tang co trong 6 gia diu va tac dung gay mach nhanh, giam huyit ap a giai doan s&m it han khi diing carbetocin
Tir khoa: oxytocin, carbetocin, anh hudng tim mach, mo lay thai, chay mau sau de
I. DAT VAN DE
Chay mau san khoa la nguyen nhan hang dlu gay t u vong me trong qua trinh thai nghen va sinh nd. Tinh trang co bop t u cung khdng du cdn gpi la d d tCf cung chilm tdi 70%
nguyen nhan gay chay mau sau de [1, 2]. Ddi vdl mo l l y thai, d l ngan ngua va han e h l dd tu cung thi viec su dung thudc tang truang luc ca tu eung hay thule tang co la thue hanh bat budc. Hien nay, oxytocin la thudc duae dung pho b i l n nhlt cho myc dich nay [3]. Tuy nhien, thuoc cd mpt s l hgn c h i nhu thdi gian ban buy n g l n (chi 4 - 1 0 phiit), c l n su dyng dudng truyin tTnh mach va cac tac dung khong mong m u l n v l tim maeh lien quan d i n lilu thulc [3]. Mae dii la thudc tang eo dupe ehon lua budc d l u nhung oxytocin cd nguy ca gay tang t i n s6 tim va giam huylt ap do
Dia chi lien he. NguySn Toan Thing Bd mon Gdy me hdi sue, Dai hoc Y Ha Noi Email- thanggsmhs@gmail com Ngay nhan-13/12/2016 Ngaydw(?c chip thuSn: 04/4/2017
tac dyng gian maeh. Do do su dyng oxytocin l i l u t h l p va tiem cham duac khuyin cao vdi tat ca san phu, dae biet vdi eac trudng hp'p ed benh tim mach va thieu khoi luang t u i n hoan [3,4]
Vdi xu hudng sinh de mugn, nen ti le san phy ed cac benh ly tim kem theo cung cd chilu hudng gia tang. Nhdng trudng hap nay dung nap vdi thay ddi huylt dpng gay ra bdi p h l u thuat, eae thule tang co tu cung kem han so vdi ngudi khde manh, d^c biet d thdi d i l m triing vdi cac tac dpng b i t lai ciia gay te tuy s i n g . Do dd thudc lua chon ben canh hieu qua tang eo bdp tie cung cdn phai an toan v l ' mat huylt dpng.
Carbetocin (1-deaminp-1-monoearba-[2-0- methyltyrpsinej-oxytocin) la mdt ddng phan tong hap cua oxytocin cd thdi gian tae dyng keo dai, thdi gian ban buy khoang 40 phiit. Ve ca e h l , carbetocin g i n chon loc vdi thy t h i oxytocin tai co tCr cung vdi ai tinh tuang t u
TCNCYH 107 (2) - 2017
TAP CHi NGHIEN CU'U Y HpC chit truyin tin thu hai va tang nIng dp caici trong t l bao, carbetocin kieh thieh co ea tran t u eung va tang truang luc tu eung [4]. So vdi oxytocin, hi^n tuang co ca nay keo dai va thudng xuyen han. Mac dii lilu tTnh mach khuyin cao phd b i l n la 100 pg, lilu hieu qua thlp nhlt van chua duac xac nhan. Trong khi do dp manh tuang duang ciia carbetocin so vdt oxytocin eiJng chua duae bilt [5], Ti le tae dyng khong mong mudn cua carbetocin duac thdng bao la tuang duang vdi oxytocin [6]
Hdi San phu khoa Canada khuyin cao car- betocin la thulc lua chpn sau md l l y thai nhlm ngan ngua chay mau va dung them thudc tang eo [5]. Nhilu nghien cuu trudc day eho thly ben canh tac dung co h l i tu cung keo dai, nhu c l u b l sung thule tang co eung it han khi su dyng carbetocin so vdi cac lieu oxytocin khac nhau [6 - 8]. Han nua su dung carbetocin cd xu hudng it gay thay d l i v l huylt ddng ban so vdi oxytocin ca d giai doan trong vasau md [9,10].
Tai Vi^t Nam g i n day carbetocin b i t d l u duae su dung trong ngan ngira va d i l u tri chay mau san khoa, tuy nhien chua cd nhilu nghien cuu danh gia su khae biet giua hai thuoc trong ngan ngua ehay mau sau m l l l y thai. Chinh vi vay chiing toi tiln hanh nghien cuu nay nhlm mue dieh so sanh hieu qua co hdi tu cung va anh hudng huyet dpng giua 100 meg carbetocin va 10 IU oxytocin tiem tTnh maeh tren cac san phu phau thuat l l y thai cd chuan bj.
II. 0 6 l TU'gNG VA PHU'aNG PHAP 1. Ddi tu'ang
80 san phy mo l l y thai co chuin bi dap U'ng cac tieu chuan,
Tieu chuin Iwa chpn:
Phan Ipai SLKC khde theo ASA I - II, t u l i tu 18 - 40, duac phlu thuat dudi gay te tuy song do tiln su mo lly thai cu
Tieu chuan loai tru:
San phy cd rau h l n dao, rau bong non, da thai, t i l n san giat, dai dudng thai k^, benh tim mgch, banh than, benh tuyIn giap. San phg dung thudc anh hudng d i n tim mach hay di ung vdi cac thudc dimg trong md. Cac trudng hap chlng chi dinh te tuy s6ng hay te tiiy sing thit bai, chay mau b i t thudng trong mo, san phu khdng ddng y tham gia nghien cdu.
2. Phuo-ng phap Thiet ke nghien cu'u:
Nghien cieu lam sang ngau nhien, mil kep thuc hien tai Khoa Gay me hdt sue Benh vien Bach Mai tif thang 3 d i n thang 9 nam 2015.
Dua tren k i t qua eiia Langesaeter [14]
huylt ap tam thu giam 40 mmHg (SD, 10) sau khi diing lilu bolus 10 IU oxytocin. De phat hien sy khae biet cd y nghTa lam sang 10 mmHg (SD, 10) vdi muc y nghTa 5 % (two- sided) va dp manh 80% c l n cd m l u mil nhdm la 17 (su dyng SamplePower; SPSS).
Chiing tdi cho ring su khac biet giua hai thuoc cd t h i it han do dd cd m l u m6i nhom duac tang len 40.
Thuoc va phwang tien:
Bao gdm may theo ddi nhilu thdng s6 cua hang GE. kim tiiy sdng 27 G ciia B/Braun, thudc Bupivacain Spinal Heavy (Ing 20mg/4ml, AstraZeneca), oxytocin (Ing 5 IU/
ml, hang Gedeon Richter, Hungah) va carbetocin (Duratocin dng 100 meg/ml, hang Draxis Pharma, Canada). Cac phu'ong tien va thudc cap ciru nhu thue hanh thudng quy,
Cac bw&c tiin hanh
Kham t i l n me va chuin bj trudc m l ap dung cho t i t ca san phu. Tai phdng mo, sau khi lap he thdng theo ddi, san phu duac dat dudng tTnh mach va truyin trudc 500 ml Ringerfundin. Bac sT gay me thii' nhlt (la
TCNCYH 107 (2) - 2017
ngudi thu thap sd lieu va x u tri d i l n biln trong va sau mo) t i l n hanh te tuy sdng d t u t h i n i m nghleng trai tgi vi tri L3.5 b l n g kim 25 G diing 8 mg bupivacain va 0,03 mg fentanyi. T i l n hanh phlu thuat sau khi kiem tra du mdc dd vd cam. Thule tang co ti> eung duo'c su dyng ngay sau khi l l y thai va cap day r i n . Bae sT gay ma thif hai (ddc lap vdi bac sT thu nhlt, bac sT san va san phu) la ngudi l l y va tiem thulc tang co sau khi rut tham n g l u nhien san phy vao hai nhdm.
Nhdm 1 ( s l thir tu ehln): diing 10 IU pxyto- cin tmh mach trong 60 giay, tiep theo truyin tTnh mach cham 40 IU/1000 ml trong 6 gid.
Nhdm II (sd thu t u le): dimg 100 mi- crogram carbetocin tTnh maeh trong 60 giay
Khi huylt ap tam thu dudi 90 mmHg hoae giam qua 20% gia tn ca ban, diing ephedrin 5 mg va nhac lai n l u c l n . N l u t i n s l tim dudi
TAP CHI NGHIEN CU'U Y HpC 60 lln/phiit diing 0,5 mg atropin sulfat.
Trudng hop khdng dap ung diing adrenalin.
Trong mo va 6 gid d l u sau m l n l u eo hli tu cung chua dit thulc tang co duac bd sung theo chi dinh eiia bac sT san khoa.
Tieu chi danh gia
Cac tieu chi chung lien quan d i n san phu, gay me va san khoa, Hieu qua co h6i tw cung duae danh gia bdi p h l u thuat vien theo 3 muc; tdt (co c h i c thanh mpt khdi, chay mau it), trung binh {co duac nhung khdng chle, chay mau dien rau bam) va kem (tu cung dd, nheo, chay mau nhilu). Luang thudc tang co c l n bo sung (oxytocin va/hoae ergotamin) Mat mau (gian t i l p qua thay doi cdng thue mau trudc va sau md) Anh hwong tim mach danh gia dua tren thay ddi v l t i n s l tim, huyet ap va cac d l u hieu lam sang va dien tim. Thai d i l m danh gia duac quy d|nh nhu sau,
Bang 1. Quy djnh t h d i diem danh gia
To: trudc gay ta 3 phut.
Ti khi rach da T2. trudc khi l l y thai T3: ngay trudc tiem thudc T4: sau khi tiem thudc 30 giay T5: sau tiem 1 phiit Tg; sau tiem 2 phut
T7 sau tiem 5 phiit Ta! sau tiem 10 phiit Tg! sau tiem 15 phiit Tio tru'dc khi ddng thanh byng TiT sau p h l u thuat 2 gid T12. sau p h l u thuat 6 gid T13: sau p h l u thuat 24 gid
Xiy iy so lieu
Su dung p h l n m I m SPSS 22.0, ap dung test Mann-Whitney de so sanh 2 gia tn trung binh, kiem dinh khi binh phuang de so sanh 2 ti le Khac biet duac col la cd y nghTa thing ke vdi p < 0,05.
3. Dao diec nghien cieu
Nghien euu nham han che nguy ca chay mau sau md l l y thai. Cac thule va l i l u diing trong nghien cuu da ap dyng pho b i l n trpng thue hanh. Trudng hap c l n thilt se duae bo sung them cac l i l u bolus iTnh mach. T i t ca san phy deu duac giai thich rd v l nghien cuu va CO t h i til' Choi hoac ngung tham gia d b i t oil! thdi diem ,nao.
TCNCYH 107 (2) - 2017
TAP CHi NGHIEN CU'U Y HOC III. KET QUA
1.00c diem chung
Bang 2. Yeu to san phu, gay me va san khoa
Y l u to Nhdm I (n=40) Nhdm II (n=40) T"ud) (nam) 27,4 ± 4,6 28.1 ±4,1 Yeu to san phy C§n n$ng (kg) 65,6 ± 7,2 65,6 ± 6,8 ChiSu cao (cm) 157,6 ± 5 , 1 157,9 + 5,4
Yeu to gay me
L3-4 34, (85%) 36, (90%) 6,(15%) 4,(10%) Lwong dich truySn (ml) 821,8 ±113,6 828,4 ± 104,6
Vj tri choc te (n, %)
"ang dich truySn (ml)
Luvng ephedrin (mg)* 16,5 ±8,3 11,7 ± 3,3
Yeu 16 san khoa
Tu6i thai (tuan) Trong Iwang thai {gram}
Thai gian mo (phut)
38,2 ±2,3 3312,5 ±372,9
37,1 ± 8,5
38,6 ±2,8 3475,0 ±416,7
31,4 ± 6,9
(Ngoai VI tri choc te, cac ket qua dwoc trinh bay dw&i dang: X ± SD) Khdng cd khae bipt y nghTa thing ke v l eae y l u t l lien quan d i n san phu, gay me va san 2. Tac dung co hdi tLf cung
Bang 3. Co hdi tCi' cung trong m l va nhu c l u bo sung tang co Nhom
Thong s6 danh gia Co h6i tu' cung trong mo
Tot Trung binh Kem
Co hoi a gio thu' 6 sau mo Tot
Trung binh Kem
Bo sung tang co trong 6 gio 6^u Oxytocin
Ergometrin
Nhom 1 (n = 40) n
21 13 6- 29 8 3
6 11
T y l ? ( % )
52,5 32,5 15 72,5
20 7,5
15 27,5
Nhom II (n = 40) n
25 14 1 31 8 1
0 2
T v l e ( % )
62,5 35 2,5 77,5 20 2,5
0 5
>0,05
>0,05
<0,05
>0,05
>0,05
>0,05
<0,05
<0,05
TI le CO hdi tu cung tdt va trung binh ngay trpng md va sau mo 6 gid tuang duang nhau giua hai nhdm (p > 0,05). Ti le co h l i kem trong mo va c l n b l sung oxytocin va/hoac ergometnn cao ban d nhdm dimg oxytocin (p < 0,05).
^^ TCNCYH 107 (2) - 2017
TAP CHI NGHIEN CU'U Y HOC Bang 4. Thay ddt cac chi sd cong thijc mau
Cong thu>c mau Wgay tnwoc mo
H d n g e l u 4.16 ±0,5 4,13 ±0,3 Hemoglobin 123,1 ±15,7 126,9 ±19,9 Hematocrit 0,36 ± 0,04 0,36 ± 0,31 Tieu c l u 246,1 ±44,1 240,5 ± 58,2 Sau md 24 gio
Hdng c l u 4,0 ± 0,4 4,06 ± 0,4 Hemoglobin 121,1 ±10,7 123,4 ±12,3 Hematocrit 0,35 ± 0,1 0,36 ± 0,33 T i e u d u 230 ± 49,6 212,4 ± 60,9
(Cac ket qua dwoc trinh bay dw&i dang: X ± SD)
Khdng ed khae biet giu'a hai nhdm v l s6 luang hdng c l u , tieu c l u , hemoglobin va hematocrit ca trudc va sau mo (p > 0,05). Trong moi nhdm cac chi sd nay d thai d i l m 24 gid sau md giam
Anh hu-dng tren tim mach
11° Tan so tim dan/ohut) - . -Nhom I NhcJm II ' p < 0,05
Thai dilm danh gia
Bieu do 1. Thay doi ve tan sd tim trong mo
T i n sd tim trung binh d cac thdi d i l m sau diing thudc tang co 30 giay, 1 va 2 phiit d nhom dijng oxytocin cao han cd y nghTa so vdi nhdm diing carbetocin (p < 0,05). Tan s l tim t h l p nhlt la 56 va cao nhlt la 145 lln/phut. C6 2 trudng hap ngoai tam thu that x u l t hien sau diing thudc d nhdm oxytpcm t y h i t sau 5 phiit.
110
Huyet ap trung binh (mmHg) Nhdm !
r 1'
Bieu do 2. Thay doi huyet fip trung binh trong mo TCNCYH 107 (2) - 2017
T>^P CHi NGHIEN CU'U Y H p c Huylt ap trung binh d ea hai nhdm tai eac thdi diem danh gia d l u trong gidi han binh thudng, tuy nhien gia trj nay d nhdm oxytocin thlp hon dang ke so vdi nhdm carbetocin tai thdi diem 1 va 2 phiit sau diing t h u l c (p >
0,05). Cd 4 san phu chia d l u d hai nhdm dau tuc nguc trai sau diing tang co nhung ch!
thoang qua.
IV. BAN LUAN
Cac san phu trong nghien ciru d l u cd t i l n su' mo l l y thai va chua cd d l u hieu chuyin da Nghien cuu nay cho thay Khdng cd su khac biel y nghTa giu'a hai nhdm ve cac y l u td hen quan d i n san phy, gay me va san khoa Day la nhCrng yeu td cd the anh hudng d i n qua trinh co h l i tir cung, chay mau d giai doan chu phau, dap irng vdi cac thuoc tang co tu cung va eac thay ddi v l t u i n hoan trong mo. Tinh ddng nhlt cao giu'a hai nhdm gJiip cho qua trinh so sdnh tac dyng eua-hai thudc dupe chinh xac han.
Trong va sau m l l l y thai, thulc tang co dup'c diing de ngan ngua va d i l u tri tinh trang 6c/ tir cung, la nguyen nhan hang d l u gay ehay mau sau mo de. Chimg tdi nhgn thly hiau qua co hdi tu cung tu muc trung binh trd len cua pxyfoem va carbetocin d thdi diem trong m l va sau gid sau mo tuang duang nhau theo ddnh gia eua p h l u thugt vien Tuy nhien. trpng m l nhom oxytocin cd ti la co hdi kem cao ban so vdi nhdm carbetocin (15% so vdl 2,5%, p < 0,05) Ben canh dd nhu c l u bd sung them thulc tang co trong 6 gid d l u sau mo cung cao han khi diing oxytocin so vdi dOng carbetocin (vdi ti le bo sung oxytocin la 15% va 0%, ergometrin la 27,5% va 5% tuang irng) Dilu nay phii hap vdi k i t luan t u tdng ket Cochrane la nhu eau bo sung thudc tang eo trong mo l l y thai it han khi diing carbetocin so vdi oxytocin [8]. Tuang tu nghien euu tren 377 san phu khi so sanh 100 meg carbetocin vdl 5 IU oxytpcin trong du phdng chay mau sau mo xac nhan nhu c l u bo sung tang co d
nhom oxytocin eao han so vdi carbetocin vditi le tuang ung la 45,5% va 33.5%, (RR; 0,74:
CI 95%; 0,57-0,95) [10]. G i n day mdt nghian cuu so sanh carbetocin, misoprostol va oxyto- cin trong ngan ngira ehay mau sau m l lay thai cd chuin bi (n = 263) eho t h l y hieu qua co h6i tir cung cua carbetocin tuong duang vdi oxy- tocin nhung uu viet han so vdi misoprostol vdl ti le c l n bd sung thudc tang co tuang irng ia6%, 13% va 22% [11].
Nghien euu nay khdng cho thly khac biet y nghTa ve cae ehi s6 gian tiep phan anh hieu qua eua thudc tang eo nhu s6 luang hlng e l u , hematocrit, hemoglobin va t i l u eau giCra hai nhdm d thdi diem trudc mo va sau m l 24 g i d . Ngay d san phy cd nguy ca chay mau cao cung khdng t h l y khac biet v l iuang mau m I t ude tinh va gia trj hemoglobin trung binh d cac thdi d i l m sau mo 2 va 24 gid giua car- betocin va oxytocin [12]. Rosales-Ortiz trong mdt nghien cuu so sanh n g l u nhien nhan Ih^y ti le san phy m I t tren 500 ml sau de thlp hen khi tiem tTnh mach 100 meg carbetocin so vdi truyin 20 IU oxytocin trong 6 gid [13] Tuy nhien lieu oxytocin trong nghien euu tac gia it han mdt nua so vdi chiing tdi.
Ngpai mpt s6 ban c h i nhu thdi gian lac dung ngan va hien tup'ng giam nhay cam khi dung nhlc lai- hoac keo dai, nhung thay ddi ve huylt dong ti le thuan vdi lilu diing nhu; gian mach, giam huylt ap. tang t i n sd tim, tang luu luang tim la cac han e h l khae eiia oxytocin, dac biet la d san phy cd nguy ea cao v l tim mach. Chimg tdi xac nhan t i n s l tim tang cd y nghTa d cac thdi d i l m 30 giay. 1 phiit va 2 phut sau tiem 10 IU oxytocin so vdi tiem 100 meg carbetocin. Trong khi huylt ap trung binh d phiit thu nhlt va hai sau tiem thudc d nhdm oxytocin t h l p han dang ke so vdi nhdm car- betocin. Tuang t u Lareiprete nhan thly huylt ap tam thu (5 phiit sau dung thudc. liie ddng tu cung va 12 gid sau mo) va huylt ap tam truang (3 va 5 phiit sau diing thudc, 12 va 24 gid sau mo) d nhdm dimg oxytocin d l u thap
100 TCNCYH 107 (2) - 2017
ban cd y nghTa so vdi nhdm carbetocin [12].
Nghien cdu v l anh hudng huylt ddng cho thly oxytPCin gay giam huyet ap va tang t i n so hm nhieu han so vdi carbetocin nhung s u khac biet nay khdng co y nghla thong kg.
Thay doi huylt ddng tdi da ghi nhgn sau 30 - 40 giay; tang t i n so tim va giam huylt ap tam thu trung binh tuang ung la 17,98 ± 2,53 l l n / phiit va 26,80 ± 2,82 mmHg vdi oxytocin va 14,20 ± 2,45 lln/phiit'va 22,98 ± 2,75 mmHg vdi carbetocin) [9]. Mpt nghien cuu tuang ty cOng khdng t h l y khae biet gida hai thudc v l huylt ap tam thu, tam truang va t i n s l tim d cac thdi d i l m danh gia trong vdng 40 phut sau diing thuoc [10]. Tuy nhien ca hai tac gia tren d l u su dung l i l u carbetocin 100 meg va oxytocin 5 IU t h l p han so vdi hlu cua chiing toi,
Nghien ciru nay t i n tai mdt sd han e h l hen quan d i n danh gia ehu quan v l co hdi tir cung, khac biet v l thdi gian va ky thuat mo giiia cac phiu thuat vien khac nhau. C l n cd them cac nghien cuu dung thee ddi huyet dOng xam l l n , danh gia co h l i tit cung khach quan han de xac nhan l i l u diing t l i uu cua mdi thudc va so sanh chinh xac han hieu qua ciia hai hlu nay. Chiing tdi cho ring sir dung 100 meg carbetocin cd t h i mang lai hieu qua CO hdi tu eung tin cay va keo dai trong khi tranh dupe vide truyin lien tye, han che diing them thuoc tang co va anh hudng bat lai tren tim maeh khi dung 10 IU oxytocin nhlt la d san phy ed nguy ca cao.
V. K^T LUAN
Khdng cd khae biet v l mire co hdi tir cung giua carbetocin hlu 100 meg tTnh mach va oxytocin (boius 10 IU t i l p theo truyin 40 IU/6 gid) trong md va thdi d i l m 6 gid sau md l l y thai cd chuan bi. Tuy nhien, nhu c l u bo sung thuoc tang co trong 6 gid d l u , mue do tang tin s l tim va giam huylt ap ngay sau tiem tTnh mach it han khi su dung carbetocin.
TAP CHi NGHIEN CU'U Y HpC Lo'i cam e n
Nhdm tac gia xin tran trong cam an PGS.TS Pham Ba Nha, Khoa Gay me hdi sue, Khoa S^n Benh vien Bach Mai va san phu v l su hop tae va giiip dd cua hp trong qua trinh thye hien nghien ciru nay.
TAI LIEU THAM KHAO 1. World Health Organization (2012). WHO recommendations for the prevention and treatment of postpartum haemprrhage 2. Khan K.S., Wojdyla D., Say L., et al (2006). WHO analysis of causes of maternal death' a systematic review. Lancet. Apr 1, 367 (5916), 1066-1074.
3. Dyer R.A., Butwick A.J. and Carvalho B (2011). Oxytocin for labour and eaesarean delivery: implications for the anaesthesiolo- gislCurr Opin Anaesthesiol 24(3). 2 5 5 - 2 6 1 . 4. Dyer R.A., van Dyk D. and Dresner A (2010). The use of uterotonic drugs dunng eaesarean section. Int J Obstet Anesth 19(3), 3 1 3 - 3 1 9 .
5. Graham L., David J.S. and David iVIc (2013). Carbetocin in the prevention and man- agement of post parlum haemorrhage: A re- view of current evidence for obstetric anaes- thesia Australasian Anaesthesia, Editor by Riley R., 95-102
6. Peters N.C, and Duvekot J.J (2009). Car- betocin for the prevention of postpartum hem- orrhage a systematic review Obstet Gynecol Surv.64i2). 129-135.
f. Holieboom C.A., Eyck J., KoenenS.V., et al (2013). Carbetocin in comparison with oxytpcin in several dosing regimens fpr the prevention of uterine atony after elective eaesarean section in the Netheriands Arch Gynecol Obstet 287(6): 111 1-1117.
8. Su L.L., Chong Y.S., Samuel M (2012).
TCNCYH 107 (2) - 2017
TAP CHI NGHIEN CU'U Y HpC Carbetocin for preventing postpartum haemor- rhage.Coc/jrane Database Syst Rev, (4):
CD005457.
9. MoertI M.G., Friedrich S., Krasch IJ., et al (2011). Haemodynamic effects of carbetocin and oxytocin given as intravenous bolus on women undergoing eaesarean delivery: a randomised trial BJOG. 118(11), 1349 1356
10. Attilakos G., Psaroudakis D., AshJ., et al (2010). Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following eaesarean section: the results of a double-bhnd randomised trial BJOG 117(8), 929 - 936
11. Elbohoty A.E.H., Mohammed W.E., Sweed M., et al (2016). Randomized controlled tnal comparing carbetocin,
misoprostol, and oxytocin for the prevention of postpartum hemorrhage following an elective cesarean delivery. International Journal of Gynecology & Obstetrics.^ 34(3), 324 - 328.
12. Lareiprete G., MontagnoM C , Frigo M., et al (2013). Carbetocin versus oxytocin in eaesarean section with high risk of post- partum haemorrhage. Journal of Prenatal hAs- dicine 7(1), 1 2 - 1 8 .
13. Rosales-Ortiz S., Aguado R,p., Hernandez R.S., et al (2014). Carbetocin versus oxytocin for prevention of postpartum haemorrhage: a randomised controlled trial.
T^e Lancef. 383, S51.
14. Langesaeter E., Rosseland LA., Stub- haug A (2006). Hemodynamic effects of oxytPcin during cesarean delivery. Int J Gyne- col Obstet 9 5 , 4 6 - 4 7 .
Summary
COMPARISON OF THE UTEROTONIC AND CARDIOVASCULAR EFFECTS OF CARBETOCIN AND OXYTOCIN IN CESAREAN SECTION
A randomized, double - blind controlled trial was carried out on 80 parturients undergoing se- lective cerasean section to compare the uterotonic (UT) effect and cardiovascular changes of slew IV injection of carbetocin 100 meg and oxytpcin 10 IU. The results shpwed that the incidenc- es of good and moderate utenne contraction in oxytocin and carbetocin groups were similar dur- ing surgery and al postoperatively 6'^ hour (85% vs 97 5% and 92.5% vs 97.5%, p > 0.05, re- spectively) The need for additional uterotoniCs was higher in oxytocin group. There were no dif- ferences in erythrocyte, hematoerite, hemoglobin and platelet ampng groups and in each group between preop and postop timepoints. The increasing heart rate and decreasing MAP al SC*"
second, hrst and 2"'' minutes in oxytocin group were more Ehan those in earbetpcm group In con- elusions, the uterotonic effect of carbetocin 100 meg and oxytocin 10 IU was comparable. How- eve^ need for additional uterotonics in hrst 6 hours after surgery and the immediate effects on HR, MAP of carbetocin were less than those of oxytoein.
Keywords; oxytocin, carbetocin, hemodynamic effects, cesarean section, postpartum haemorrhage.
TCNCYH 107 (2) ' 2017
