低分子肝素钙对妊娠子痫患者肾功能、凝血功能及血压的影响

The effects of low molecular heparin calcic on the renal function,blood coagulation function and blood pressure in treatment of pregnancy patients with preeclampsia

目的观察妊娠子病患者应用低分子肝素钙对肾功能、凝血功能及血压等指标的影响。方法 2013年1月—2015年8月湖北文理学院附属襄阳市中心医院妇产科诊治妊娠子痫患者72例。按照抽签法随机分为观察组和对照组,每组36例。对照组以硫酸镁治疗,观察组在此基础上联合低分子肝素钙治疗。比较2组患者肾功能、凝血功能、血压及妊娠结局。结果治疗前后2组患者的血肌酐、尿素氮浓度均无明显差异。治疗后,观察组患者血尿酸、尿蛋白定量低于对照组[(235.24±10.21)μmol/L vs.(305.16±12.12)μmol/L、(0.87±0.08)g/24h vs.(1.26±0.45)g/24h,P<0.05],凝血酶时间(TT)、活化部分凝血酶原时间(APTT)长于对照组[(15.26±2.12)s vs.(13.54±1.67)s、(38.75±3.56)s vs.(35.26±3.42)s,P<0.05];治疗后和治疗前2组患者的血小板体积(MPV)、血小板计数(PLT)、纤维蛋白原(Fbg)、凝血酶原时间(PT)比较无明显变化(P>0.05);治疗后观察组收缩压和舒张压分别为(141±18)mmHg、(92±9)mmHg,对照组为(142±17)mmHg、(93±8)mmHg,2组均低于治疗前(P<0.05),而组间比较差异无统计学意义(P>0.05);2组的分娩孕期、胎盘早剥率、产后出血率、新生儿体质量、胎儿窘迫发生率、新生儿病死率、胎儿生长受限发生率差异均无统计学意义(P>0.05),但观察组中的Apgar评分≥7分的发生率88.89%(32/36)高于对照组66.67%(24/36),剖宫产率13.89%(5/36)低于对照组36.11%(13/36),差异均有统计学意义(P<0.05)。结论低分子肝素钙对产妇血压无影响,但明显改善肾功能和凝血功能,并不增加母婴风险,安全有效。

Objective To study the effects of low molecular heparin calcic on the renal function,blood coagulation function index and blood pressure in the treatment of pregnancy patients with preeclampsia.Methods Seventy-two pregnancy patients with preeclampsia in our hospital from January 2013 to August 2015 were divided into observation group and control group according to the draw method,36 cases in each group.Control group were given magnesium sulfate,on the basis of control group,the observation group were treated combined with heparin calcium.The renal function,blood coagulation function,blood pressure,pregnancy outcome of the two groups were compared.Results The concentration of serum creatinine,urea nitrogen concentration of the two groups of patients had no obvious difference before and after treatment.After treatment,blood uric acid,urine protein quantitation of observation group were obviously lower than the control group[（235.24 ± 10.21）μmol/L vs.（305.16±12.12）μmol/L,（0.87 ±0.08）g/24 h vs.（1.26 ±0.45）g/24 h,P〈0.05],which was a statistically significant difference（P〈0.05）,and thrombin time（IT）,activated partial prothrombin time（APTT） were longer than the control group[（15.26±2.12）s vs.（13.54 ± 1.67）s,（38.75 ±3.56） s vs.（35.26 ±3.42） s,P〈0.05],but platelet volume（MPV）,platelet count（PLT）,fibrinogen（Fbg）,prothrombin time（PT） had no significant change in the two groups before and after treatment（P〉0.05）.After treatment,the systolic and diastolic blood pressure of the observation group were respectively（141 ±18） mmHg,（92 ±9） mmHg,and in the control group were respectively（142 ±17） mmHg,（93 ±8） mmHg,lower than before treatment（P〈0.05）,but there was no significant difference between two groups（P〉0.05）.There were no differences in the incidence of delivery cycle,neonatal body quality,the incidence of fetal distress,neonatal mortality,rate of placental abruption,incidence rate of postpartum hemorrhage,fetal growth restriction between the two groups（P〉0.05）,but the Apgar score≥7 in the observation group was 88.89%（32/36）,higher than the control group 66.67%（24/36）,while cesarean section rate was 13.89%（5/36）,lower than the control group 36.11%（13/36）,with a statistical significance difference（P〈0.05）.Conclusion Low molecular heparin calcic,which belong to the safe and effective drugs,will not affect the maternal blood pressure,can improve kidney and blood coagulation functions and will not increase maternal and infant risk.