低分子肝素联合硫酸镁治疗早发型子痫前期疗效观察

Curative effect of early onset preeclampsia with low molecular weight heparin combined with magnesium sulfate

目的研究在硫酸镁治疗方案的基础上加用低分子肝素(LMWH)治疗早发型子痫前期的疗效。方法选择2011年1月至2012年5月间北京妇产医院早发型子痫前期患者186例,随机分为观察组(n=96)和对照组(n=90)。对照组单纯使用硫酸镁治疗,观察组在使用硫酸镁治疗的基础上加用LMWH治疗。观察2组患者临床和实验室指标的变化及母儿并发症发生情况。结果治疗后2组患者血压均下降;与对照组比较,观察组尿蛋白定量减少,D-二聚体水平降低,肾功能改善,子宫动脉和脐动脉收缩期峰值流速/舒张末期流速比值显著降低,孕周延长,产时并发症的发生率降低,差异均有统计学意义(P<0.05)。产后出血量无增加,围产儿结局改善。结论应用LMWH联合硫酸镁治疗早发型子痫前期患者,与单一使用硫酸镁比较,可改善患者凝血功能和肾功能,降低子宫动脉和脐动脉阻力,改善母儿妊娠结局。

Objective To study the efficacy of the treatment of early onset preeclampsia with magnesium sulfate plus low molecular weight heparin（LMWH）. Methods A total of 186 patients with early onset preeclampsia were selected in Bei- jing Maternity Hospital from January 2011 to May 2012. The patients were randomly divided into observation group（ n = 96） and control group（n = 90）. The cases of the observation group were treated with magnesium sulfate plus LMWH, and the cases of the control group were treated with magnesium only. The changes of clinical and laboratory indexes of patients, and the situation of complications of the mother and fetus were observed. Results The blood pressure in the two groups were both decreased af- ter treatment. Compared with the control group,the quantitation of urinary protein decreased,the level of D-dimer declined,the renal function improved in the observation group, the differences were significant（ P 〈 0.05 ） ;and uterine artery and umbilical artery peak systolic velocity/end diastolic velocity ratio was significantly decreased, gestational age extended, the incidence ratio of complications reduced, perinatal outcome improved in the observation group, the differences were significant （ P 〈 0. 05 ）. There was no increasing in postpartum hemorrhage in the observation group. Conclusion Compared with the single use of magnesium sulfate, the uses of LMWH combined with magnesium sulfate in the treatment of patients with early onset pre- eclampsia can make the coagulation index and renal function improved, uterine artery and umbilical artery resistance reduced and pregnancy outcomes of mother and fetus improved.