低分子肝素对妊娠糖尿病伴凝血功能异常患者的疗效及母婴结局的影响

Therapeoutic effect of low molecular weight heparin on gestational diabetes mellitus with coagulation dysfunction and its influence on maternal and fetal outcomes

目的分析低分子肝素治疗妊娠糖尿病(GDM)伴凝血功能异常患者的临床疗效及对母婴结局的影响。方法选取2015年3月-2019年3月在本院治疗的GDM伴凝血功能异常患者68例,随机数表法分为2组,分别为阿司匹林组(常规干预+小剂量阿司匹林,34例)和肝素组(常规干预+低分子肝素,34例)。比较2组干预前后的凝血指标变化、产妇不良分娩结局、围生儿不良结局发生情况及用药期间的不良反应发生率。结果干预后,2组的血小板计数(PLT)、血浆纤维蛋白原(FIB)、D二聚体(D-D)均降低(P<0.01),活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、国际标准化比值(INR)均增加(P<0.05),与阿司匹林组比较,肝素组的D-D、FIB更低(P<0.01);肝素组的总不良分娩结局发生率低于对照组(P<0.05)。肝素组的围生儿总不良结局发生率低于对照组(P<0.05)。2组血小板减少、牙龈出血、低血糖发生率及总不良反应发生率比较,差异无统计学意义(P>0.05),肝素组的胃肠道反应发生率低于阿司匹林组(P<0.05)。结论低分子肝素治疗G DM伴凝血功能障碍患者效果确切,并可降低母婴不良结局发生率,安全可靠。

Objective To analyze the clinical effect of low molecular weight heparin in the treatment of gestational diabetes mellitus(GDM)with coagulation dysfunction and its effect on maternal and fetal outcomes.M ethods Sixty-eight patients with GDM and coagulation dysfunction admitted to our hospital from March 2015 to March 2019 were randomly divided into aspirin group(conventional intervention+low-dose aspirin,34 cases)and heparin group(conventional intervention+low molecular weight heparin,34 cases).The changes of coagulation indexes before and after intervention were compared between the two groups.The adverse outcomes of parturient and perinatal were compared and the incidence of adverse reactions was compared between the two groups.R esults The platelet(PLT),fibrinogen(FIB)and D-dimer(D-D)in the heparin group and aspirin group were decreased after intervention(P<0.01),and activated partial thromboplastin time(APTT),prothrombin time(PT),and international normalized ratio(INR)were increased(P<0.05).Compared with the aspirin group,the D-D and FIB of the heparin group were lower(P<0.01).The incidence of total adverse delivery outcomes in the heparin group was lower than that in the aspirin group(P<0.05).The incidence of total adverse outcomes in perinatal children in the heparin group was lower than that in the aspirin group(P<0.05).There was no statistical significance on the difference in the incidence of thrombocytopenia,gingival bleeding,hypoglycemia and total adverse reactions between the two groups(P>0.05).The incidence of gastrointestinal reaction in heparin group was lower than that in aspirin group(P<0.05).Conclusion Low molecular weight heparin is effective in the treatment of patients with GDM with coagulopathy,and can reduce the incidence of adverse outcomes in mothers and infants,which is safe and reliable.