阿司匹林对妊娠合并慢性高血压患者血小板聚集率及妊娠结局的影响

Effect of aspirin on platelet aggregation rate and pregnancy outcome in pregnant women with chronic hypertension

目的探讨阿司匹林对妊娠合并慢性高血压患者血小板聚集率及妊娠结局的影响。方法选取2015年1月至2018年1月在河北省唐山市协和医院规范产前检查及分娩的妊娠合并慢性高血压患者106例。按是否服用阿司匹林分为观察组(54例)和对照组(52例)。对照组给予常规解痉、降压、镇静等治疗;观察组在对照组基础上于孕13～16周开始给予阿司匹林100 mg/d晚饭后口服,直至孕36～37周停止。比较2组患者血小板计数及血小板聚集率的变化,妊娠结局及产后出血量。结果 2组患者孕中期、孕晚期血小板计数差异均无统计学意义(均P>0.05)。2组孕中期血小板聚集率差异无统计学意义(P>0.05),孕晚期观察组血小板聚集率低于对照组[(73±20)%比(86±18)%],差异有统计学意义(P<0.01)。观察组患者子痫前期、胎儿生长受限的发生率低于对照组[29.6%(16/54)比50.0%(26/52)、13.0%(7/54)比28.8%(15/52)],差异有统计学意义(P<0.05)。按计划停用阿司匹林的观察组患者与对照组比较,产后出血量及不同等级出血占比差异均无统计学意义(均P>0.05)。未能按计划停药的观察组患者(紧急终止妊娠)中等及大量出血的发生率及出血量明显高于/大于对照组和按计划停药观察组患者[中等:46.2%(6/13)比43.4%(23/52)、41.5%(17/41),(398±33)ml比(353±48)、(354±39)ml;大量:38.5%(5/13)比26.4%(14/52)、31.7%(13/41),(820±89)ml比(716±77)、(704±89)ml],差异均有统计学意义(均P<0.05)。结论小剂量阿司匹林可降低患者的血小板聚集率,改善妊娠结局;按计划停用阿司匹林者,产后出血量无明显增加,但紧急终止妊娠未及时停药者,产后出血量增加。

Objective To explore the effect of aspirin on platelet aggregation rate and pregnancy outcome in pregnant women with chronic hypertension. Methods A total of 160 cases of pregnancy complicated with chronic hypertension in Tangshan Union Medical College Hospital from January 2015 to January 2018 were divided into observation group（n＝54） and control group（n＝52）. The control group was treated with conventional antispasmodic, antihypertensive and sedative treatments; the observation group was treated with aspirin 100 mg/d at 13-16 weeks of pregnancy on the basis of conventional treatments until 36-37 weeks of pregnancy. Platelet count, platelet aggregation rate, pregnancy outcomes and postpartum hemorrhage volume were analyzed. Results There were no significant differences of mid- and late-pregnancy platelet count and mid-pregnancy platelet aggregation rate between groups（P〉0.05）. Late-pregnancy platelet aggregation rate in observation group was significantly lower than that in control group［（73±20）% vs（86±18）%］（P〈0.01）. Incidence rates of preeclampsia and fetal growth restriction in observation group were significantly lower than those in control group［29.6%（16/54）vs 50.0%（26/52）, 13.0%（7/54）vs 28.8%（15/52）］（P〈0.05）. Discontinuing aspirin in observation group showed no significant difference of postpartum hemorrhage volume compared to that in control group（P〉0.05）. Incidences of moderate and massive hemorrhage and hemorrhage volume in patients with emergency termination of pregnancy（not discontinuing aspirin） in observation group were significantly higher/more than those in control group and discontinuing aspirin group［moderate hemorrhage： 46.2%（6/13） vs 43.4%（23/52）, 41.5%（17/41）; （398±33）ml vs （353±48）,（354±39）ml; massive hemorrhage： 38.5%（5/13） vs 26.4%（14/52）, 31.7%（13/41）; （820±89）ml vs （716±77）,（704±89）ml］（P〈0.05）. Conclusions Low dose aspirin can reduce platelet aggregation rate and improve pregnancy outcome in pregnant patients with chronic hypertension. Patients who stop taking aspirin in time show low risk of postpartum hemorrhage.