低分子肝素钠辅治妊娠期肝内胆汁淤积症的效果

Efficacy of low molecular weight heparin sodium on intrahepatic cholestasis of pregnancy

目的观察低分子肝素钠辅治妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)的效果。方法选取本院接诊的ICP孕妇182例为研究对象,按随机数字表法分为对照组(采用熊去氧胆酸治疗,91例)和研究组(在对照组基础上加用低分子肝素钠治疗,91例)。对比分析2组孕妇的临床疗效。分析2组孕妇治疗前后的凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、组织型纤溶酶原激活物(tissue-type plasminogen activator,t-PA)、总胆汁酸(total biliary acid,TBA)、总胆红素(total bilirubin,TBIL)和丙氨酸转氨酶(alanine transaminase,ALT)水平。对比分析2组孕妇和新生儿的妊娠结局。结果治疗后,研究组的总有效率显著高于对照组(P<0.05)。治疗后,研究组的PT和t-PA高于对照组,FIB、TBA、TBIL和ALT水平低于对照组(P<0.05)。研究组孕妇的分娩周数长于对照组(P<0.05)。研究组的剖宫产率和产后出血率低于对照组,阴道分娩率高于对照组(均P<0.05)。研究组新生儿5 min Apgar评分高于对照组(P<0.05)。研究组新生儿的早产率、新生儿窒息率和宫内窘迫率低于对照组(P<0.05)。结论低分子肝素钠辅治ICP疗效确切,不仅可以改善孕妇凝血功能与肝功能,还可以延长妊娠时间,降低剖宫产与早产率。

Objective To observe the efficacy of low molecular weight heparin sodium in the treatment of intrahepatic cholestasis of pregnancy(ICP).Methods A total of 182 pregnant women with ICP admitted to our hospital were selected as the research subjects.They were randomly divided into control group(91 cases treated with ursodeoxycholic acid)and research group(91 cases treated with low molecular weight heparin sodium on the basis of control group).The clinical effects of two groups of pregnant women were compared and analyzed.The levels of prothrombin time(PT),fibrinogen(FIB),tissue-type plasminogen activator(t-PA),total bile acid(TBA),total bilirubin(TBIL)and alanine transaminase(ALT)were statistically analyzed before and after treatment.The pregnancy outcomes of pregnant women and newborns in two groups were compared and analyzed.Results After treatment,the total effective rate of the research group was significantly higher than that of the control group(P<0.05).After treatment,PT and t-PA in the research group were higher than those in the control group,and the levels of FIB,TBA,TBIL and ALT in the research group were lower than those in the control group(P<0.05).The delivery weeks of pregnant women in the research group were longer than those in the control group(P<0.05).The cesarean section rate and postpartum hemorrhage rate in the research group were lower than those in the control group,while the vaginal delivery rate was higher than that in the control group(all P<0.05).The 5-min Apgar score of newborns in the research group was higher than that in the control group(P<0.05).The premature birth rate,neonatal asphyxia rate and intrauterine distress rate in the research group were lower than those in the control group(P<0.05).Conclusion Low molecular weight heparin sodium is effective in the treatment of ICP.It can not only improve the coagulation function and liver function of pregnant women,but also prolong the pregnancy time,reduce the rate of cesarean section and preterm delivery.