低分子肝素治疗胎儿生长受限对子宫动脉血流灌注的影响

Analysis of the effect of low molecular weight heparin on uterine artery blood perfusion in the treatment of fetal growth restriction

目的 探讨低分子肝素治疗胎儿生长受限对子宫动脉血流灌注的影响。方法 将2020年1月—2020年12月嘉兴市妇幼保健院诊治的84例FGR孕妇按随机数表法分为对照组与观察组,对照组(42例)接受加强营养及复方氨基酸等常规治疗,观察组(42例)在常规治疗基础上再施以低分子肝素辅助治疗。比较两组胎儿治疗后生长参数及宫高增长情况,治疗前后动脉血流指标,羊水指数,凝血功能指标以及治疗后随访的妊娠结局情况。结果 观察组各疗程治疗后头围(12.4±2.5)mm、腹围(22.6±3.4)mm、股骨长(2.2±0.4)mm、双顶径(2.8±0.5)mm及宫高(7.9±1.4)mm均高于对照组[(10.7±2.1)mm、(20.3±2.9)mm、(1.8±0.3)mm、(2.3±0.4)mm、(6.8±1.1)mm],差异均有统计学意义(t=3.374、3.336、5.185、5.061、4.003,均P<0.05);观察组治疗后动脉血流指标RI(0.82±0.31)、PI(0.54±0.16)及S/D(2.24±0.41),较对照组的(1.02±0.37)、(0.80±0.22)、(2.73±0.45)更低,差异均有统计学意义(t=2.685、6.194、5.216,均P<0.05),而观察组羊水指数(15.18±2.57)cm,高于对照组的(12.92±2.41)cm,差异有统计学意义(t=4.157,P<0.05);观察组凝血指标TT(17.43±1.81)s、FIB(3.24±0.52)g/L、D-D(0.57±0.21)mg/L,较对照组的(19.60±2.02)s、(3.63±0.61)g/L、(0.74±0.26)mg/L更低,差异均有统计学意义(t=4.420、3.153、3.296,均P<0.05),观察组不良妊娠结局发生率57.14%,低于对照组的78.57%,差异有统计学意义(χ^(2)=4.421,P<0.05)。结论 低分子肝素可有效提高胎儿生长受限患者子宫动脉血流灌溉效率,缓解血流受阻、血液高凝情况,促进子宫血供循环,为胎儿生长发育提供充足的营养物质,继而提高胎儿生长质量,并保障母婴安全。

Objective To investigate the effect of low molecular weight heparin on uterine arterial blood perfusion in the treatment of fetal growth restriction.Methods The 84 cases of FGR pregnant women diagnosed and treated in Jiaxing Maternity and Child Health Care Hospital from January 2020 to December 2020 were divided into a control group and an observation group according to a random number table.The control group(42 cases) received conventional treatments such as enhanced nutrition and compound amino acids, and observed The group(42 cases) was given adjuvant treatment with low molecular weight heparin on the basis of conventional treatment.The growth parameters and uterine height growth, arterial blood flow index, amniotic fluid index, blood coagulation function index before and after treatment were compared between the two groups of fetuses after treatment, and the pregnancy outcome during follow-up after treatment was compared.Results The head circumference(12.4±2.5)mm, abdominal circumference(22.6±3.4)mm, femur length(2.2±0.4)mm, double parietal diameter(2.8±0.5)mm and uterine height(7.9±1.4)mm in the observation group after each course of treatment were higher than those in the control group [(10.7±2.1)mm,(20.3±2.9)mm,(1.8±0.3)mm,(2.3±0.4)mm,(6.8±1.1)mm] high(t=3.374, 3.336, 5.185, 5.061, 4.003, P<0.05);After treatment, the arterial flow indexes RI(0.82±0.31), PI(0.54±0.16) and S/D(2.24±0.41) in the observation group were lower than those in the control group(1.02±0.37),(0.80±0.22) and(2.73±0.45),the difference is statistically significant(t=2.685, 6.194, 5.216).The amniotic fluid index of observation group(15.18±2.57) cm was higher than that of control group(12.92±2.41) cm(t=4.157, P<0.05).Coagulation index TT(17.43±1.81) s, FIB(3.24±0.52) g/L, D-D(0.57±0.21) mg/L, The levels of(19.60±2.02) s,(3.63±0.61) g/L and(0.74±0.26) mg/L in the control group were lower than those in the control group(t=4.420, 3.153, 3.296, allP<0.05).The incidence of adverse pregnancy outcomes in the observation group was 57.14%.Compared with 78.57% in control group(χ^(2)=4.421,P<0.05).Conclusion Low molecular weight heparin can effectively improve the irrigation efficiency of uterine artery blood flow in patients with fetal growth restriction, relieve blood flow obstruction and blood hypercoagulation, promote uterine blood supply and circulation, provide sufficient nutrients for fetal growth and development, and then increase fetal growth Quality, and guarantee the safety of mother and child.