低分子肝素联合丹参治疗复发性流产的疗效分析

Effect of Low Molecular Heparin Combined with Salvia Miltiorrhiza in the Treatment of Recurrent Spontaneous Abortion

目的:探讨低分子肝素(LMWH)联合丹参治疗血栓前状态(PTS)和(或)自身免疫因素所致的复发性流产(RSA)患者的临床结局,分析治疗效果。方法:选择2016年10月至2018年10月就诊于贵州医科大学附属医院生殖中心的PTS和(或)自身免疫因素所致的185例RSA患者,根据治疗意愿,124例采用LMWH联合丹参治疗的患者纳入联合组,61例采用LMWH治疗的患者纳入单药组。比较两组妊娠结局、凝血指标和LMWH使用量、胎盘血流指数水平、妊娠期并发症及药物不良反应情况。结果:联合组孕期保胎成功率、抱婴率、分娩孕周及新生儿出生体质量均明显高于单药组,差异均有统计学意义(P<0.05);联合组孕早期D-二聚体、纤维蛋白原(FIB)、孕期LMWH总使用量、孕中期胎盘脐血流指数[收缩期/舒张压(S/D)、搏动指数(PI)、阻力指数(RI)]、羊水过少、胎儿生长受限(FGR)及胎盘早剥的发生率均明显低于单药组,差异有统计学意义(P<0.05)。联合组患者用药过程中过敏和总不良反应的发生率低于单药组,差异有统计学意义(P<0.05);联合组孕期PLT水平、早产、前置胎盘、妊娠期高血压疾病(HDP)、产后出血、新生儿窒息及死亡的发生率均低于单药组,但差异无统计学意义(P>0.05)。结论:LMWH联合丹参治疗RSA患者,可改善高凝状态及胎儿脐血流指标,降低胎盘相关疾病的发生率,提高保胎成功率,不良反应少,安全性高。

Objective:To investigate the clinical efficacy of low molecular weight heparin( LMWH) combined with Salvia miltiorrhiza in the treatment of recurrent spontaneous abortion( RSA) caused by prethrombotic state( PTS) and/or autoimmune factors. Methods:185 patients with RSA caused by PTS and/or autoimmune factors in the reproductive medicine center of affiliated hospital to Guizhou Medical University from October 2016 to October 2018 were included. According to the willing of patients,124 patients as treatment group were treated with LMWH and Salvia miltiorrhiza. 61 cases as control group were treated with LMWH. The differences in pregnancy outcomes,coagulation function,dosage of LMWH,placental blood flow index,pregnancy complications and side effects of medicine were compared between two groups. Results:The successful rate of pregnancy in first trimester,live birth rate,gestational age of delivery and birth weight of newborn in treatment group were significantly higher than those in control group( P < 0. 05). The D-dimer lever in early pregnancy,fibrinogen,the total dose of LMWH,S/D,PI and RI of umbilical artery,oligohydramnios,fetal growth restriction and placental abruption in treatment group were significantly lower than those in control group( P < 0. 05). The incidence of allergies and total adverse reactions in treatment group were significantly lower than those in control group( P < 0. 05). In spite the level of platelet,the incidence of premature birth,placenta previa,hypertensive disorders of pregnancy,postpartum hemorrhage,neonatal asphyxia and death rate in treatment group were lower than those in control group,but there were no significant differences( P > 0. 05). Conclusions:LMWH combined with Salvia miltiorrhiza in the treatment of RSA can ameliorate the hypercoagulable state and the fetal umbilical blood flow index,reduce the incidence of placenta-related diseases and improve the successful rate of pregnancy in the first trimester,and with fewer adverse reaction and high safety.