子宫动脉血流异常的不明原因复发性流产的治疗方法探索

Study on Treatment of Unexplained Recurrent Spontaneous Abortion with Abnormal Uterine Artery Blood Flow

目的研究不明原因复发性流产(URSA)患者的子宫动脉血流动力学,寻找针对性强、有效的治疗方法,改善URSA患者的妊娠结局。方法选取2019年3月至2020年3月在四川大学华西第二医院门诊就诊的黄体中期子宫动脉血流参数异常的URSA患者66例为研究对象,按照随机数字表法分为A、B两组,每组33例。妊娠前(非孕期):A、B组分别予小剂量阿司匹林预处理2个月和1个月;妊娠后:两组均予小剂量阿司匹林联合低分子肝素治疗。观察两组患者非孕期、孕早期的子宫动脉血流参数变化及其妊娠结局。结果URSA患者子宫动脉血流参数异常率达83.5%,经小剂量阿司匹林预处理后,两组子宫动脉血流阻力均明显下降,A组子宫动脉血流参数正常的比例高于B组,差异有统计学意义(P<0.05)。孕6周时A组子宫动脉血流参数正常的比例高于B组,差异有统计学意义(P<0.05)。对孕6周时两组中仍存在血流异常的患者经相应处理后,孕9周时A组子宫动脉血流参数正常的比例高于B组,差异无统计学意义(P>0.05)。最终A组孕早期妊娠丢失率低于B组,差异有统计学意义(P<0.05)。结论URSA患者存在子宫动脉血流参数异常,异常升高的子宫动脉血流阻力可能是其流产的重要原因之一。妊娠前进行小剂量阿司匹林预处理,妊娠后继续阿司匹林联合低分子肝素治疗,对改善其子宫动脉血流动力学和妊娠结局都有重要价值,妊娠前阿司匹林预处理2个月的患者改善效果优于预处理1个月的患者。

Objective To study the uterine artery hemodynamics of patients with unexplained recurrent spontaneous abortion(URSA),so as to find targeted and effective treatment methods to improve the pregnancy outcome of URSA patients.Methods A total of 66 URSA patients with abnormal uterine artery flow parameters in the middle luteal phase who visited the outpateint department of West China Second Hospital of Sichuan University from March 2019 to March 2020 were selected and randomly divided into group A(n=33)and group B(n=33)according to random number table method.Before pregnancy(non pregnancy),group A was pretreated with low-dose aspirin for 2 months,while group B was pretreated for 1 month.During pregnancy,all patients were treated with low-dose aspirin combined with low molecular weight heparin.Changes of uterine artery blood flow parameters during non-pregnancy and first trimester,and pregnancy outcomes in the two groups were observed.Results The abnormal rate of uterine artery blood flow parameters in URSA patients was 83.5%.After pretreatment with low-dose aspirin,the uterine artery blood flow resistance in both groups decreased significantly,and the proportion of normal uterine artery blood flow parameters in group A was higher than that in group B,which was with statistically significant difference(P<0.05).At 6 weeks of pregnancy,the proportion of normal uterine artery flow parameters in group A was higher than that in group B,and the difference was statistically significant(P<0.05).After corresponding treatment of patients with abnormal blood flow in the two groups found at 6 weeks of pregnancy,the proportion of normal uterine artery blood flow parameters in group A at 9 weeks of pregnancy was higher than that in group B,and the difference was not statistically significant(P>0.05).The final pregnancy loss rate in the first trimester in group A was lower than that in group B,and the difference was statistically significant(P<0.05).Conclusion Abnormal uterine artery blood flow parameters in are common URSA patients.The abnormally elevated uterine artery blood flow resistance may be one of the important causes of abortion.Pretreatment with low-dose aspirin before pregnancy,and continued aspirin treatment combined with low molecular weight heparin during pregnancy is of great value in improving uterine artery hemodynamics and pregnancy outcome.The improvement effect of aspirin pretreatment for 2 months before pregnancy was better than that for 1 month.