不同剂量低分子量肝素治疗胎儿生长受限的临床效果

目的:评价不同剂量低分子肝素治疗胎儿生长受限的临床疗效及安全性。方法:将52例胎儿生长受限患者随机分为2组,分别使用低剂量(L组)和中等剂量(M组)的低分子肝素治疗,分别于治疗前、治疗后1周、终止妊娠前行彩色超声检查,监测胎儿生长情况和脐血流变化,同时监测各项凝血指标,记录新生儿情况并进行随访。结果:①低剂量和中等剂量组治疗后胎儿生长情况比较,无显著性差异(P>0.05)。②两组治疗后脐动脉收缩期最大血流速度(S)与舒张末期血流速度(D)的比值(S/D比值)、搏动指数(PI)、阻力指数(RI)均明显降低,差异有显著性(P<0.001),M组S/D值下降程度较L组明显,但差异无显著性(P>0.05)。③M组新生儿的胎龄、体重、身长及胎盘重量均大于L组,但差异无显著性(P>0.05),在新生儿预后方面两组间比较差异无显著性。④治疗后M组PT及APTT均较治疗前有所延长,但差异无显著性,而皮下瘀斑发生率明显高于L组;两组间产后出血量及产后出血发生率比较,差异无显著性。结论:低分子肝素可以改善胎盘血流,从而有效治疗胎儿生长受限,其低剂量组的疗效与中等剂量组相近,对凝血功能无明显影响,不增加产后出血的发生率,对母儿的安全性优于中等剂量组,且用药量少、使用方便、产妇易于接受,更适于推广。

Clinical efficacy of low molecular weight heparin of different dosages in treatment of fetal growth restriction

Objective:To evaluate the clinical efficacy and safety of low molecular weight heparin of different dosages in treatment of fetal growth restriction (FGR).Methods:52 cases with FGR were divided into two groups,then they were treated by low dosage low molecular weight heparin (low dosage group) and middle dosage low molecular weight heparin (middle dosage group),respectively,color Doppler ultrasound was carried out before treatment,one week after treatment and before the termination of pregnancy,the fetal growth state,changes of umbilical artery blood flow and coagulation indexes were monitored,the neonatal state was recorded and follow-up was conducted.Results:①There was no difference in fetal growth state between the two groups after treatment (P>0.05).②In two groups,the ratio of umbilical maximum blood velocity in systolic phase/umbilical maximum blood velocity in end diastolic phase (S/D),pulse index (PI) and resistance index (RI) after treatment were lower than those before treatment (P<0.001);the descend degree of S/D in middle dosage group was more faster than that in low dosage group,but there was no significant difference (P>0.05).③The fetal age,weight,body length and placenta weight of middle dosage group were significantly larger than those of low dosage group,but there was no significant difference;there was no significant difference in prognosis of neonates between the two groups.④In middle dosage group,PT and APTT after treatment were longer than those before treatment,but there was no significant difference,the incidence of hypodermic petechia in middle dosage group was higher than that in low dosage group;there was no significant difference in amount and incidence of postpartum hemorrhage between the two groups.Conclusion:Low molecular weight heparin can improve blood flow of placenta and treat fetal growth restriction effectively.The curative effects of low dosage low molecular weight heparin and middle dosage low molecular weight heparin are similar,the former doesn't affect coagulation function and doesn't increase incidence of postpartum hemorrhage,which is superior to middle dosage low molecular weight heparin in safety and low dose,and can be accepted easily by pregnant women.