低分子肝素和丹参抗凝治疗早发型重度子痫前期病例的临床疗效研究

目的:了解丹参、低分子肝素等抗凝药物对早发型重度子痫前期的治疗作用。方法:2006年1月～2010年3月将我院产科病房子痫前期患者65例前瞻性随机分为丹参组23例,低分子肝素组11例,丹参+低分子肝素组15例,对照组16例,收集各组患者的一般情况、分娩情况,对比分析治疗前后的尿蛋白、血常规、出凝血系列、肝肾功能、血脂等指标,了解治疗效果。结果:(1)丹参+低分子肝素组的治疗时间为11.13天,丹参组为9.05天,显著长于(SNK值不同)其他组;(2)新生儿分娩孕周平均为32.45±2.74周,新生儿体重为1533.19±489.71g,围产儿死亡率215.4‰。孕产妇死亡率0%;剖宫产率84.61%,顺产率1.54%,引产率13.85%。各组间分娩孕周、新生儿体重、围产儿和孕产妇死亡率均无显著差异(SNK均为A)。分娩的手术指征以胎儿窘迫、疾病加重为主要因素;(3)各组间治疗前后血常规、肝肾功能、凝血指标中的PT、FIB对比差值无显著差异(SNK均为A),而低分子肝素组TT增加1.35s,APTT增加3.33s,显著长于其他组(SNK值不同)。24h尿蛋白丹参组增加0.6g,增加值少于其他组。结论:应用丹参或丹参+低分子肝素治疗子痫前期患者可延长孕周,丹参缓解尿蛋白明显,低分子肝素缓解高凝状态明显,药物的有效性尚需进一步大样本研究。

Clinical study on the treatment of the early onset severe preeclampsia women with Salvia Miltiorrhiza L(SML)and Low Molecular Weight Heparin(LMWH)

Objective:To estimate the therapeutic effect of anticoagulants including Salvia Miltiorrhiza L(SML) and Low Molecular Weight Heparin(LMWH) to the preeclampsia women.Methods:From January 2006 to March 2010,65 preeclampsia women from the obstetric department of east part of Renji Hospital affiliated to Shanghai Jiaotong University were involved in this prospective research project.The participants were randomly divided into four groups:SML group(23 cases),LMWH group(11 cases),SML+LMWH group(15 cases) and control group(16 cases).The ordinary information and delivery information of these participants were collected,and some lab-tests as the urine protein,blood cells count,coagulation function test,liver and renal function test,blood-fat test and so on were compared pre and post treatment.The effects of medicines were estimated.Results:(1)The therapeutic time in SML+LMWH group and SML group were 11.13d and 9.05d,which was longer than other groups(SNK different).(2) The average delivery week and newborn bodyweight were 32.45±2.74week and 1533.19±489.71g,the prenatal mortality of newborn and mothers were 215.4‰ and 0%,the rate of caesarean section and eutocia were 84.61% and 1.54%.There were no obviously difference among four groups of delivery week,newborn bodyweight,mortality of perinatal women and babies(SNK were all A).The important reasons of operation were fetal distress and unsatisfied treatment.(3) There were no statistical differences in the D-value(the test's value of before treatment subtract the value of after treatment) of tests including routine blood test,liver and renal function test,PT and FIB in coagulation function test among four groups(SNK were all A).In the LMWH group,the D-value of TT and APTT prolonged 1.35s and 3.33s,which were obviously longer than other groups.The D-value of 24h urine protein increased in SML group 0.6g,which were less than other groups.Conclusions:Using SML or SML+LMWH can prolong the pregnant time;using SML can decrease the urine protein of preeclampsia,meanwhile,using LMWH can also relieve the hypercoagulable state of these patients,whereas,there are still needed large samples study to ascertain the effective of these medicines.