阿司匹林和低分子肝素预防子痫前期的研究进展

阿司匹林可改善胎盘微循环,预防胎盘功能障碍导致的一系列不良妊娠结局。国内外指南普遍推荐妊娠早期使用小剂量阿司匹林(LDA)能够预防子痫前期(PE),特别是早产型PE(<37孕周分娩),但对小于胎龄儿(SGA)、流产、死胎等方面有待进一步研究。低分子肝素(LMWH)具备安全抗凝血的作用,但在预防PE、SGA、死胎、流产方面的作用微小或无作用,妊娠期长期应用均不增加胎盘早剥和产前产后出血的风险。本文综述指南推荐的PE危险因素以及早期筛查模型,讨论LDA和LMWH应用的理论依据以及两者预防效益的研究进展,帮助产科医生在临床实践中对LDA和LMWH的使用有更深层次的理解。

Progress of the Prophylactic Treatment of Pre-Eclampsia with Use of Aspirin and Low Molecular Weight Heparin

Aspirin can improve placental microcirculation and prevent a series of adverse outcomes caused by placental dysfunction.Guidelines recommend generally that the use of low dose aspirin(LDA)in the first trimester can prevent pre-eclampsia,especially preterm pre-eclampsia(less than 37 weeks of delivery),but further studies are needed for its effect on small for gestational age(SGA),abortion and stillbirth.Low molecular weight heparin(LMWH)has a safe anticoagulant effect,but has little or no effect in preventing placental mediated pregnancy complications including pre-eclampsia and SGA.Long-term application of LDA and LMWH during pregnancy did not increase the risk of placental abruption,prenatal and postpartum hemorrhage.This review summarizes the recommended risk factors for pre-eclampsia and early screening models,discusses the theoretical basis for the use of LDA and LMWH as well as the research progress in the prevention of complications.Ultimately,we hope it will help the obstetricians gain a deeper understanding of the use of LDA and LMWH in clinical practice.