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低分子肝素钙对早发型重度子痫前期患者临床疗效与母体血清学指标及母婴结局的影响
孙建华,王龙琼,漆洪波
0
(重庆医科大学附属第一医院产科)
摘要:
目的 探讨低分子肝素钙对早发型重度子痫前期患者临床疗效、母体血清学指标及母婴结局的影响。方法 选取2013年2月~2016年10月于我院就诊的87例早发型重度子痫前期患者作为研究对象,孕周均为26~34周,回顾性分析患者的临床资料,根据不同治疗方法将其分为对照组43例和研究组44例,对照组采用常规治疗,研究组采用常规治疗联合低分子肝素钙治疗,对比两组患者各项临床指标、母体血清学指标和母婴结局。结果 治疗前两组患者24h尿蛋白定量及平均动脉压对比,差异无统计学意义(P>0.05);治疗后研究组患者24h尿蛋白定量、平均动脉压均明显低于对照组,差异有统计学意义(P<0.05);两组治疗后与各自治疗前对比,差异均有统计学意义(P<0.05)。治疗前两组患者视网膜病变I、II、III级对比,差异无统计学意义(P>0.05);治疗后研究组视网膜病变I、II、III级与对照组对比,差异有统计学意义(P<0.05)。两组患者治疗前羊水指数及S/D值对比,差异无统计学意义(P>0.05);治疗后研究组羊水指数及S/D值明显优于对照组,差异有统计学意义(P<0.05)。两组患者治疗前DD、Fg、PLT、APTT及PT等凝血功能指标及Hcy对比,差异无统计学意义(P>0.05);治疗后研究组患者DD、Fg和Hcy明显低于对照组,差异有统计学意义(P<0.05);对照组患者治疗后PLT、APTT及PT等与治疗前对比,差异无统计学意义(P>0.05)。两组患者治疗前血脂水平对比,差异无统计学意义(P>0.05);治疗后研究组患者apo-A、HDL-C明显高于对照组,而apo-B、LDL-C、TC和TG明显低于对照组,差异均有统计学意义(P<0.05)。两组维持妊娠时间、胎盘重量、新生儿体重及失血量对比,差异均有统计学意义(P<0.05)。研究组治疗后羊水过少率(4.55%)明显低于对照组(30.23%),差异有统计学意义(P<0.05)。两组新生儿Apgar 1min评分和Apgar 5 min评分对比,差异均有统计学意义(P<0.05)。结论 在早发型重度子痫前期治疗中,低分子肝素钙可提高临床疗效,改善母体血清学指标及母婴结局,值得临床推广应用。
关键词:  早发型重度子痫前期  低分子肝素钙  血脂  血浆同型半胱氨酸  母婴结局
DOI:
基金项目:国家自然科学基金重点国际合作项目(81520108013)
The influence of clinical efficacy, maternal serum markers and maternal and child outcomes of low molecular heparin calcium in the treatment of early onset severe pre-eclampsia
ianhua,WANG Longqiong,QI Hongbo
(Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University)
Abstract:
Objective To research the influence of clinical efficacy, maternal serum markers and maternal and child outcomes of low molecular heparin calcium in the treatment of early onset severe preeclampsia. Methods 87 early onset severe preeclampsia patients with 26-34 gestational weeks in our hospital between February 2013 and October 2016 were selected. The clinical data of all patients were analyzed by retrospective analysis. According to different treatment methods, they were divided into control group (43 cases) and research group (44 cases). The cases in the control group were treated by traditional method, while the cases in the research group were treated by traditional method combined with low molecular heparin calcium. The clinical efficacy, maternal serum markers and maternal and child outcomes of two groups were compared. Results The 24h urine protein quantity and mean arterial pressure of the two groups before treatment had no statistical difference (P>0.05). The 24h urine protein quantity and mean arterial pressure of research group after treatment were both much less than control group (P<0.05). The 24h urine protein quantity and mean arterial pressure of two groups after treatment had statistical difference respectively (P<0.05). The retinopathy such as I, II and III degree of two groups before treatment had no statistical difference(P>0.05). The I, II and III degree of research group after treatment had statistical difference with control group(P<0.05). The amniotic fluid volume and S/D ratio of two groups before treatment had no statistical difference(P>0.05). The amniotic fluid volume and S/D ratio of research group after treatment were much better than control group (P<0.05). The coagulation function indexes such as DD, Fg, PLT, APTT and PT and Hcy of the two groups before treatment had no statistical difference (P>005). The DD, Fg and Hcy of research group after treatment were much lower than control group(P<0.05). The PLT, APTT and PT of control group after treatment had no statistical difference with pre-treatment(P>0.05). The serum lipid indexes of two groups before treatment had no statistical difference(P>0.05). The apo-A and HDL-C of research group after treatment were much higher than control group(P<0.05). The apo-B, LDL-C, TC and TG of research group were much lower than control group (P<0.05).The extended gestational age, weight of placenta, weight of neonatus and blood loss after delivery of two groups had statistical difference (P<0.05). The rate of oligohydramnios (4.55%) in the study group was significantly lower than that of the control group (30.23%) (P<0.05). The 1 minute Apgar score after birth of two groups had statistical difference(P<0.05), and the 5 minute Apgar score after birth of two groups had statistical difference(P<0.05).Conclusion In the treatment of early onset severe pre-eclampsia, low molecular weight heparin Ca can improve the clinical efficacy, improve maternal serum indexes and maternal and child outcomes , and is worthy of clinical promotion.
Key words:  Early onset severe pre eclampsia  Low molecular heparin Ca  Blood lipids  Plasma homocysteine  Maternal and child outcomes

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