低分子肝素钠在心脏病换瓣术后妊娠早期的应用探讨

目的探讨低分子肝素钠在心脏病换瓣术后妊娠早期的应用。方法本文选取55例心脏病换瓣术后孕妇，在妊娠早期使用低分子肝素钠进行抗凝治疗（简称治疗组），并随机选取55例心脏病换瓣术后孕妇，在妊娠早期使用华法林作为对照（简称对照组）。结果治疗组55例，发现胎儿畸形2例，发生率3．63％；自然流产4例，发生率7．27％抗凝效果良好45例，占81．81％，1例出现心脏瓣膜功能障碍而重新换瓣并终止妊娠，发生率1．81％，。对照组55例，发现胎儿畸形8例，发生率14．55％；自然流产12例，发生率21．81％；抗凝效果良好53例，占96．36％；未发现心脏瓣膜功能障碍病例。两组在胎儿畸形和自然流产比较，差异有显著性（P〈0．05）。结论心脏病换瓣术后妊娠早期抗凝剂选用低分子肝素钠胎儿致畸率及自然流产相对较低，但抗凝效果及导致孕妇心脏瓣膜功能障碍华法令稍优于低分子肝素钠。故心脏病换瓣术后患者在妊娠早期抗凝剂选择用低分子肝素可以降低胎儿畸形率及自然流产率，对母婴无明显副作用，是一种安全、有效的药物。

Use of low molecular weight heparin for women in their first trimester after heart valve replacement

Objective To investigate the use of low molecular weight heparin for women in their first trimester after heart valve replacement. Methods 55 pregnant women in their first trimester after heart valve replacement received anticoagulant therapy with low molecular weight heparin （ study group ）, and another 55 pregnant women with the same medical conditions received warfarin （ control group ）. Results In the study group, fetal malformation was found in 2 of 55 women （ 3.63% ）, spontaneous abortion occurred in 4 （ 7.27% ）, and cardiac valve dysfunction developed in one woman （ 1.81% ） and she needed repeat valve replacement and termination of pregnancy; the anticoagulant effect was better in 45 women （ 81.81% ）. In the control group, fetal malformation was found in 8 women （ 14.55% ）, spontaneous abortion occurred in 12 （ 21.81% ）; the anticoagulant effect was bettere in 53 women （ 96.36% ） and heart valve dysfunction was not found. The incidence rates of fetal malformation and spontaneous abortion differed significantly between the two groups （ P 〈 0.05 ）. Conclusions Low molecular weight heparin for women in their first trimester after heart valve replacement has lower incidence rates of spontaneous abortion and fetal malformation, but has a lower anticoagulant effect than warfarin and might induce heart valve dysfunction. It is a safe and effective medication.