低分子肝素治疗晚期妊娠羊水过少疗效分析

Therapeutic effect of low molecular weight heparin on oligohydramnios in late pregnancy

目的观察分析低分子肝素(LMWH)治疗晚期妊娠羊水过少的临床疗效与凝血功能变化。方法选取2016年5月～2018年2月大冶市人民医院产科收治的100例晚期妊娠羊水过少的产妇,随机分成两组,每组50例,一组采用静脉补液的方法常规治疗,另一组在常规静脉输液治疗的基础上加用LMWH。随机选取30例晚期妊娠羊水量正常且无不适的产妇,不作任何治疗作为正常对照组,治疗前分别记录三组产妇彩超检查的羊水指数(AFI)及脐动脉血流阻力(S/D比值),治疗一周后再复查彩超,测量并记录AFI及S/D比值,对AFI及S/D比值仍为异常的产妇,继续同样用药治疗一周后再次复查。检测记录LMWH组治疗前后的血小板计数及凝血功能,测量三组产妇产后出血量。结果一周后正常对照组AFI稍减少,S/D无明显变化。治疗前常规治疗组和LMWH组AFI及S/D差异无统计学意义(P> 0.05),治疗一周后LMWH组AFI较常规治疗组和正常对照组明显增多,S/D下降,差异有统计学意义(P <0.05)。对治疗一周后两组中AFI <8cm或S/D> 3.0的病例维持同样方法继续治疗一周,对比两组产妇两周后的治疗情况,50例常规治疗组对AFI、S/D无效果的共16例,LMWH组无效果5例,治疗有效率LMWH组明显高于常规静脉输液治疗组,差异有统计学意义(χ~2=6.523,P <0.05)。LMWH组治疗前后血小板计数及凝血功能检测差异无统计学意义(P> 0.05),未发现LMWH治疗引起的凝血功能障碍。产后出血量三组之间差异无统计学意义(P <0.05)。结论 LMWH治疗晚期妊娠羊水过少可以增加羊水量,效果明显,改善妊娠结局,且安全可靠,具有临床推广使用的价值。

Objective observe and analyze the clinical efficacy and coagulation function of low molecular weight heparin（LMWH） in the treatment of oligohydramnios in late pregnancy.Methods One hundred women with late pregnancy oligohydramnios admitted to the Department of Obstetrics, Daye People＇s Hospital from May 2016 to February 2018 were randomly divided into two groups, 50 in each group, one group was treated with intravenous rehydration, and the other was treated with intravenous rehydration. The group was given LMWH on the basis of conventional intravenous infusion therapy. 30 women with normal amniotie fluid and no discomfort were randomly selected as the normal control group. The amniotie fluid index（AFI） and umbilical arterial blood flow resistance（S/ I） ratio） of the three groups of maternal color Doppler ultrasound were recorded before treatment. After one week of treatment, the color Doppler ultrasound was reviewed. The AFI and S/D ratios were measured and recorded. For the mothers whose AFI and S/D ratios were still abnormal, they should be reviewed again after one week of treatment. The platelet count and coagulation function before and after treatment in the LMWH group were recorded, and the postpartum hemorrhage in the three groups was measured. Results After a week, the AFI in the normal control group decreased slightly, but S/D did not change significantly. There was no significant difference in AFI and S/ D between routine treatment group and LMWH group before treatment（P 〉 0.05）. AFI in LMWH group increased significantly and S/D decreased significantly compared with routine treatment group and normal control group one week after treatment（P 〈 0.05）. After one week of treatment, the patients with AFI 〈 8cm or S/D 〉 3.0 in the two groups were treated with the same method for one week. Compared with the treatment of the two groups after two weeks, there were 16 eases with no effect on AFI and S/D in the 50 routine treatment group and 5 eases with no effect in the LMWH group. The effective rate of the treatment in the LMWH group was significantly higher than that in the routine intravenous infusion treatment group, and the difference was statistically significant. Significance （x2= 6.523, P 〈 0.05）. There was no significant difference in platelet count and coagulation function before and after treatment in LMWH group（P 〉 0.05）, and no coagulation dysfunction caused by LMWH treatment was found. There was no significant difference in the amount of postpartum hemorrhage between the three groups（P 〉 0.05）. Conclusion LMWH treatment of gestational oligohydramnios in late pregnancy can increase the amount of amniotic fluid, the effect is obvious, improve the pregnancy outcome, and it is safe and reliable, and has the value of clinical promotion.