低分子肝素联合阿司匹林治疗对妊娠期易栓症患者凝血功能的影响

Effect of low molecular weight heparin combined with Aspirin on coagulation function in patients with thrombophilia during pregnancy

目的探讨低分子肝素联合阿司匹林治疗对易栓症孕妇凝血功能的影响。方法选取2018年1月-2021年6月于徐州市妇幼保健院产科门诊就诊的76例妊娠期易栓症孕妇作为研究对象,采用随机数字表法分为研究组(n=38)与对照组(n=38)。对照组患者予以低分子肝素治疗,分娩前24 h停用肝素;研究组患者予以低分子肝素联合阿司匹林治疗,肝素于分娩前24 h停药,阿司匹林在孕36周停药。比较2组患者治疗前后的凝血功能、血小板相关参数及妊娠结局的差异。结果治疗后,2组患者的凝血酶原时间(PT)、D-二聚体(D-D)、凝血酶时间(TT)、纤维蛋白原(FBG)水平均低于治疗前,部分凝血活酶时间(APTT)水平高于治疗前,且研究组患者的PT、TT、FBG、D-D水平降低幅度及APTT水平升高幅度均显著大于对照组(P<0.05)。治疗后,2组患者的血小板平均体积(MPV)、血小板计数(PLT)水平显著低于治疗前,且研究组降低幅度均显著大于对照组(P<0.05)。研究组的妊娠高血压综合征率、胎儿生长受限率、早产率、新生儿窒息率均显著低于对照组(P<0.05)。结论低分子肝素联合阿司匹林治疗可有效改善妊娠期易栓症患者的凝血功能,缓解血液高凝状态,降低机体血栓形成风险,有效减少不良妊娠结局。

Objective To investigate the effect of low molecular weight heparin combined with aspirin on coagulation function in pregnant women with thromboembolism.Methods76 pregnant women with thromboembolism complicating pregnancy treated in the obstetric clinic of Xuzhou maternal and child health hospital from January 2018 to June 2021 were selected as the research objects.They were randomly divided into the research group(n=38)and the control group(n=38).The patients in the control group were treated with low molecular weight heparin,and heparin was stopped 24 hours before delivery;Patients in the study group were treated with low molecular weight heparin combined with aspirin.Heparin was stopped 24 hours before delivery,and aspirin was stopped at 36 weeks of pregnancy.The differences of coagulation function,platelet related parameters and pregnancy outcome between the two groups were compared before and after treatment.ResultsAfter treatment,the levels of prothrombin time(PT),D-Dimer(D-D),thrombin time(TT)and fibrinogen(FBG)in the two groups were significantly lower than those before treatment,and the levels of partial thromboplastin time(APTT)were significantly higher than those before treatment.The decrease and increase of Pt,TT,FBG and D-D levels in the study group were significantly greater than those in the control group(P<0.05)。After treatment,the levels of mean platelet volume(MPV)and platelet count(PLT)in the two groups were significantly lower than those before treatment,and the levels of MPV,PLT and PCT in the study group were significantly lower than those in the control group(P<0.05).The rates of pregnancy induced hypertension syndrome,fetal growth restriction,premature delivery and neonatal asphyxia in the study group were significantly lower than those in the control group(P<0.05).Conclusion Low molecular weight heparin combined with aspirin can effectively improve the coagulation function,alleviate the hypercoagulable state,reduce the risk of thrombosis and effectively reduce the adverse pregnancyoutcome.