低分子肝素治疗孕晚期产前非显性DIC的临床研究

A clinical study of low molecular weight heparin on the treatment of disseminated intravascular coagulation prophase state in pregnant woman

目的探讨有产科并发症的非显性弥漫性血管内凝血（DIC）的孕晚期患者，应用低分子肝素（LMWH）治疗后，观察减少产后出血和DIC的发生情况。方法将D-二聚体（D—D）〉5．0mg／L有产科并发症的40例患者分为2组：低分子肝素组（20例），LMWH0.3ml腹壁皮下注射，12h一次，1～4d；低分子右旋糖酐（低右）组（20例），低右500ml＋丹参20ml，静脉滴注1～7d。结果孕晚期D—D较非孕妇明显增高，差异有统计学意义（P〈0．05）。有产科并发症患者应用LMWH后D—D明显下降（P〈0.01），产后出血量和DIC发生率明显减少，与低右组比较差异有统计学意义（P〈0．05）。结论LMWH可降低D—D、减少产后出血及预防DIC的发生，安全有效，值得推广应用。

Objective To investigate the effects of low molecular weight heparin （LMWH） on the treatment of postpartum hemorrhage and disseminated intravascular coagulation （DIC） for gravida with complication and prophase of DIC during the gestational late period. Method Forty patients with pathologic obstetrics D-Dimer blood serum level 〉 5. 0mg/L were randomly divided into LMWH treatment group and low molecular dextran treatment group with 20 patients in each group. The patients in LMWH group were treated with 0. 3ml LMWH subcutaneous injection in abdominal wall in every 12h for 1 -4 d. The patients in low molecular dextran group were treated with 500ml low molecular dextran plus 20ml danshen root, intervenous drop infusion for 1 -Td. Results The D-Dimer blood serum level in the gestational late period was significantly higher than that of nongravida group （ P 〈 0. 05 ）. In the patients of LMWH treatment group, the D-Dimer blood serum level, the amount of postpartum hemorrhage, and the incidence of the DIC were significantly lower than those of low molecular dextran treatment group （ all P 〈 0. 05）. Conclusion With the treatment of LMWH, the D-Dimer level, the amount of postpartum hemorrhage, and the incidence of the DIC are decreased. The LMWH is safe and effective for the patients with postpartum hemorrhage and DIC.