抗凝治疗改善早孕期子宫动脉血流阻力增高的随机对照分析

目的确定低分子肝素(LMWH)与小剂量阿司匹林(LDA)联合使用对早孕流产史患者的子宫动脉血流和妊娠结果。方法纳入2019年1月至2021年7月在本院收治的≥1次早孕胎停史患者107例,其中59例纳入观察组,48例纳入对照组。对照组在确认宫内早孕后予黄酮软胶囊补充治疗,观察组在对照组黄酮软胶囊补充治疗基础上加用LMWH+LDA进行治疗。定期监测并比较两组患者孕期子宫动脉血流参数、流产率、活产数及其他不良反应发生情况。结果治疗前后两组患者子宫动脉血流阻力指数(RI)、收缩期峰值与舒张末期流速比(S/D)、血流搏动指数(PI)差异无统计学意义(P>0.05),但两组患者子宫动脉收缩期血流频谱消失或反向发生率差异有统计学意义(P<0.05),且观察组再发流产率明显低于对照组,差异有统计学意义(P<0.05)。结论LMWH+LDA治疗可改善有胎动史患者的子宫动脉血流,降低流产率,提高生育率。

Objective To investigate the effect of low-dose aspirin(LDA)combined with low molecular weight heparin(LMWH)on uterine artery blood flow and pregnancy outcomes in patients with a history of early pregnancy loss.Methods From January 2019 to July 2021,107 earlypregnancy patients with one or more histories of early pregnancy loss who were admitted to Quzhou People's Hospital were recruited and divided into the intervention group(n=59)and the control group(n=48)by simple randomization.The control group was treated with flavonoids soft capsules after confirming intrauterine early pregnancy,and the intervention group was treated with LDA+LMWH and flavonoids soft capsules.The uterine artery blood flow parameters,abortion rate,number of live births and adverse reactions were compared between two groups.Results There was no significant difference in resistance index(RI)of uterine arteries,systolic to diastolic velocity ratio(S/D),and blood pulsatility index(PI)in both groups before and after treatment(P>0.05).However,there is a statistically significant difference in the disappearance or reversal rate of uterine artery Doppler flow spectrum between the two groups of patients(P<0.05).The miscarriage rate of the intervention group was significantly lower than that of the control group(P<0.05).Conclusion LDA+LMWH might improve uterine artery blood flow,reduce abortion rate and increase live birth rate in patients with a history of early pregnancy loss.