丹参注射液与低分子肝素治疗胎儿生长受限的临床疗效比较

Compare of Clinical Effect Between Compound Injection of Red Sage Root and Low Molecular Heparin on Fetus Growth Restriction

目的比较丹参注射液与低分子肝素治疗胎儿生长受限的临床疗效。方法 2012年1月~2014年12月期间,我院产科门诊正规产前检查,确诊并收治入院的FGR孕妇56例。根据患者入院顺序的单双号,将患者分为对照组和观察组两组,每组各28例。孕妇入院后采取左侧卧位,每日低流量吸氧两次,每次30 min;均衡饮食,同时给予静脉补充微量元素、氨基酸、葡萄糖。对照组患者静滴复方丹参注射液30 m L/日。观察组患者每日皮下注射低分子肝素钙0.4 m L（速碧林）。两组均以7日为一个疗程,在一个疗程结束后休息7日,开始下一个疗程,直至分娩。比较两组患者平均治疗周期数,治疗前后胎儿生长变化,脐动脉血流变化,凝血功能变化,两组新生儿情况及围产期并发症发生情况。结果对照组平均接受（3.0±1.2）个周期的治疗,观察组平均接受（3.1±1.3）个周期的治疗,两组患者间治疗周期数的比较,差异无统计学意义（t=0.430,P=0.566）。在治疗过程中,胎儿均有显著生长,观察组胎儿生长情况优于对照组胎儿,两组间各项指标比较,差异均有统计学意义（P〈0.05）。两组患者治疗后,脐动脉血流均有显著改善,S/D比值（脐动脉收缩期最大血流速度S/脐动脉舒张期最大血流速度D）、搏动指数PI、阻力指数RI均显著下降,观察组患者下降幅度更大,两组患者治疗后脐动脉血流指标的比较,差异均有统计学意义（P〈0.05）。两组患者治疗前后凝血功能未见明显影响,两组患者间治疗前后相关指标的比较,差异均无统计学意义（P〉0.05）。两组患儿分娩时胎龄无统计学差异（P〉0.05）;观察组新生儿出生体重及身长、新生儿1 min Apgar评分均优于对照组,两组间差异具有统计学意义（P〈0.05）;两组均未见新生儿窒息、胎死宫内及产后出血,两组早产儿发生率差异无统计学意义（P〉0.05）,对照组娩出足月小样儿比例高于观察组,两组间比较,差异具有统计学意义（P〈0.05）。结论低分子肝素治疗FGR安全高效,优于丹参注射液。

Objective To compare the clinical effect between compound injection of red sage root and low molecular heparin on growth retardation of fetus. Methods 56 pregnant women with fetal growth restriction（ FGR） during Jan 2012 and Dec 2014 were grouped into Control Group and Observed Group equally by odd or even number of their admission number. Patients in Control Group were given intravenous infusion of 30 ml compound injection of red sage root,once a day while patients in Observed Group were given 0. 4ml low molecular heparin subcutaneously,once a day. A 7- day course of treatment was followed- up by a 7- day intermission,and then the same treatment course was restarted. The number of treatment course,the fetal growth before and after treatment,the blood flow of umbilical artery,the coagulation function,the neonatology and perinatal morbidity were compared between the two groups. Results There was not statistical difference between the two groups in number of treatment course [（ 3. 0 ± 1. 2） for Control Group vs（ 3. 1 ± 1. 3） for Observed group]. All parameters about fetal growth during treatments in Observed Group were statistically better than in Control Group. The decline margins of S / D,RI,PI were statistically bigger in Observed Group than in Control Group. None obvious effect on coagulation function was detected. There were not statistical differences between the two groups in gestational age and premature birth rate. The birth weight,birth height and 1min Apgar score of new arrivals and in Observed Group were all statistically better than those in Control Group. Conclusion The low molecular heparin is a preferable choice for FGR.