L-精氨酸联合黄芪治疗胎儿生长受限

L-arginine combined with Astragalus membranaceus for fetal growth restriction

目的探讨L-精氨酸联合黄芪治疗胎儿生长受限(FGR)的临床疗效。方法 FGR患者120例,随机分为常规治疗组、L-精氨酸组(常规治疗+L-精氨酸15 g加入体积分数5%葡萄糖500 mL静脉滴注)和L-精氨酸联合黄芪治疗组(常规治疗+L-精氨酸15 g加入体积分数5%葡萄糖500 mL静脉滴注+黄芪20 mL加入体积分数5%葡萄糖250 mL静脉滴注),每组40例。随机选择正常妊娠者40例为正常对照组。孕期定期B超监测胎儿生长发育参数及脐血流变化,产后比较新生儿出生体质量和围生儿结局。结果 L-精氨酸联合黄芪治疗组与常规治疗组、L-精氨酸组比较,小于胎龄儿的发生率下降,差异有统计学意义(P<0.05);L-精氨酸联合黄芪治疗组新生儿平均出生体质量高于常规治疗组和L-精氨酸治疗组,差异有统计学意义(P<0.05)。治疗后L-精氨酸联合黄芪治疗组双顶径(BPD)、腹横径(AD)、胸径(CD)、股骨长(FL)及腹围(AC)均高于L-精氨酸治疗组,差异有统计学意义(P<0.05);L-精氨酸治疗组BPD、AD、CD、FL及AC均高于常规治疗组,差异有统计学意义(P<0.05)。治疗后L-精氨酸治疗组、L-精氨酸联合黄芪治疗组与常规治疗组比较,收缩期峰值/舒张期峰值比率(S/D)、搏动指数(PI)及阻力指数(RI)均下降,而快速血流比值(FBVR)升高(P<0.05)。结论 L-精氨酸联合黄芪能有效改善胎儿胎盘血供,促进胎儿生长发育,增加新生儿出生体质量,降低小于胎龄儿的发病率。

Objective To study the clinical effect of L-arginine combined with Astragalus membranaceus for fetal growth restriction（FGR）.Methods One hundred and twenty-two patients with FGR were randomly divided into three groups,forty patients in each group.The patients in conventional treatment group were given routine therapy.The patients in L-arginine group were given routine therapy combined with L-arginine,which was a conventional treatment with additional L-Arginine 15 g in 5% glucose 500 mL.The patients in L-arginine＋Astragalus membranaceus group were given routine therapy,L-arginine 15 g in 5% glucose 500 mL and Astragalus membranaceus 20 mL in 5% glucose 250 mL.Forty cases of normal pregnancy were served as normal control group.The parameters of development and growth of fetal and changes of cord blood flow in four groups were monitored by type-B ultrasonic during the regular period,and the birth weight and perinatal fetus outcome were compared after parturition.Results Compared with L-arginine group,and conventional treatment group,the average birth weight of L-arginine＋Astragalus membranaceus group was significantly higher（P0.05）,while the incidence of newborns with small for gestational age of L-arginine＋Astragalus membranaceus group was significantly lower（P0.05）.After treatment,compared with conventional treatment group,the biparietal diameter（BPD）,abdominal diameter（AD）,chest diameter（CD）,femur length（FL） and abdomen circumference（AC） of L-arginine group increased significantly（P0.05）,and in L-arginine＋Astragalus membranaceus group they increased more significantly than that of L-arginine group（P0.05）.Compared with conventional treatment group,the fast blood veloeity rate（FBVR） of L-arginine group and L-arginine＋Astragalus membranaceus group were significantly higher（P0.05）,while the systolie/diastolie ratio（S/D）,pulse index（PI） and resistant index（RI） were lower（P0.05）.Conclusion The method of L-arginine combined with Astragalus membranaceus can improve the blood supply of placenta effectively,prompt fetal growth and development,increase birth weight and reduce the incidence of small for gestational age.