当归芍药散联合小剂量低分子肝素钙辅治妊娠期子宫肌瘤红色变性疗效及对母婴结局的影响

Effect of adjuvant therapy with Danggui Shaoyao Powder combined with low molecular weight heparin calcium on red degeneration of hysteromyoma in pregnancy and its effect on maternal and infant outcomes

目的探讨当归芍药散联合小剂量低分子肝素钙辅助治疗妊娠期子宫肌瘤红色变性的效果及对母婴结局的影响。方法选取石家庄市妇幼保健院2014年1月—2018年12月收治的60例妊娠期子宫肌瘤红色变性患者为研究对象,采用随机数字表法均分为观察组和对照组。对照组给予对症+硫酸镁+低分子肝素钙治疗,观察组在对照组治疗基础上加服当归芍药散。统计2组体温恢复正常时间、宫缩消失时间、肌瘤部位压痛消失时间,比较2组治疗7 d后临床疗效,记录2组治疗期间不良反应发生情况,检测2组治疗前及治疗7 d后全血高低切黏度,随访2组母体不良妊娠结局(剖宫产、产后出血、早产)和胎儿/新生儿不良妊娠结局(胎儿窘迫、胎儿畸形、新生儿窒息)。结果观察组患者体温恢复正常时间、宫缩消失时间、肌瘤部位压痛消失时间均明显短于对照组(P均<0.05)。治疗7 d后,观察组治疗总有效率为86.7%(26/30),对照组为66.7%(20/30),观察组显著高于对照组(P<0.05);治疗期间观察组和对照组总不良反应发生率分别为16.7%(5/30),36.7%(11/30),观察组明显低于对照组(P<0.05)。治疗7 d后观察组全血高切黏度和低切黏度均明显低于治疗前及对照组治疗后(P<0.05);对照组治疗前后全血高切黏度和低切黏度比较差异均无统计学意义(P均>0.05)。观察组母体不良妊娠结局总发生率为30.0%(9/30),胎儿/新生儿不良结局总发生率为6.7%(2/30),对照组分别为63.3%(19/30)和23.3%(7/30),观察组母体不良妊娠结局总发生率及胎儿/新生儿不良妊娠结局总发生率均明显低于对照组(P均<0.05)。结论当归芍药散联合小剂量低分子肝素钙辅助治疗妊娠期子宫肌瘤红色变性不仅可明显缩短体温恢复、宫缩消失、肌瘤部位压痛消失时间,疗效显著安全,且可改善体内血液高凝状态和母体及胎儿/新生儿妊娠结局。

Objective It is to investigate the effect of adjuvant therapy with Danggui Shaoyao Powder combined with low molecular weight heparin calcium on red degeneration of hysteromyoma in pregnancy and its effect on maternal and infant outcomes.Methods A total of 60 patients with red degeneration of uterine fibroids treated in Shijiazhuang Maternal and Child Health Hospital from January 2009 to December 2018 were enrolled as the study subjects.The patients were divided into observation group and control group by random number table.The control group was given symptomatic treatment+magnesium sulfate+low molecular weight heparin calcium,the observation group was given Dangui Shaoyao Powder based on the control group.The recovery time of normal body temperature,disappearance time of uterine contractions,and disappearance time of tenderness at fibroids were counted in the 2 groups,the clinical efficacy after 7 days of treatment was compared between the 2 groups,the occurrence of adverse reactions during the treatment was recorded,and the whole blood high and low cut viscosity were detected before and 7 days after treatment,the maternal adverse pregnancy outcome(cesarean section,postpartum hemorrhage,premature delivery)and fetal/neonatal adverse pregnancy outcome(fetal distress,fetal malformation,neonatal asphyxia)were followed up.Results The recovery time of normal body temperature,disappearance time of uterine contractions,and disappearance time of tenderness at fibroids in the observation group were significantly shorter than those in the control group(P<0.05).After 7 days of treatment,the total effective rate was 86.7%(26/30)in the observation group,which was higher than 66.7%(20/30)in the control group(P<0.05);the incidence of adverse reactions during the treatment period was 16.7%(5/30)in the observation group,which was lower than 36.7%(11/30)in the control group(P<0.05).After 7 days of treatment,the high-cut viscosity and low-cut viscosity of whole blood in the observation group were significantly lower than those before treatment and after treatment in the control group(P<0.05);there was no significant difference in the indexes before and after treatment in the control group(P>0.05).The total incidence of adverse maternal pregnancy outcomes in the observation group was 30.0%(9/30),the total incidence of fetal/neonatal adverse outcomes was 6.7%(2/30),and those in the control group were 63.3%(19/30)and 23.3%(7/30),respectively,the total incidence of adverse maternal pregnancy outcomes and the fetus/newborn adverse pregnancy outcomes were significantly lower than those of the control group(P<0.05).Conclusion Adjuvant therapy with Danggui Shaoyao Powder combined with low molecular weight heparin calcium not only can significantly shorten the time for body temperature recovery,disappearance of uterine contractions,and disappearance of tenderness at the fibroids with good efficiency and safety,but also can improve the blood hypercoagulability in the body and the pregnancy outcome of the mother and fetus/newborn in the treatment of red degeneration of uterine leiomyoma.