目的:运用循证医学方法评价低分子肝素(LMWH)联合硫酸镁治疗早发型重度子痫前期的疗效。方法:计算机检索Cochrane Library、PubMed、Web of Science、CA、CNKI、万方等数据库并查阅检索到的纳入文献的参考文献,尽可能获取所有相关文献...目的:运用循证医学方法评价低分子肝素(LMWH)联合硫酸镁治疗早发型重度子痫前期的疗效。方法:计算机检索Cochrane Library、PubMed、Web of Science、CA、CNKI、万方等数据库并查阅检索到的纳入文献的参考文献,尽可能获取所有相关文献。制定严格的纳入和剔除标准,依据Cocharane手册5.1.0质量评价标准对纳入文献进行质量评价。采用Review Manager5.3软件进行meta分析。结果:最终纳入27篇RCT,共纳入2363例早发型重度子痫前期患者。meta分析结果显示,低分子肝素联合硫酸镁治疗能改善早发型重度子痫前期患者平均动脉压(MAP)[均数差(WMD)=-6.73,95%CI:-9.65～-3.81,P<0.001]、收缩压(SBP)(WMD=-6.46,95%CI:-12.33～-0.58,P<0.001)、舒张压(DBP)(WMD=-6.01,95%CI:-8.34～-3.68,P<0.001)、24h尿蛋白(WMD=-0.87,95%CI:-1.22～-0.53,P<0.001)、24h尿量(WMD=640.14,95%CI:301.06～979.22,P<0.001)、血小板计数(PLT)(WMD=3.61,95%CI:1.44～5.79,P=0.71)、活化部分凝血酶时间(APTT)(WMD=2.20,95%CI:0.94～3.46,P<0.001)、血红细胞压积(HCT)(WMD=-1.36,95%CI:-1.62～-1.10,P<0.001)、凝血酶原时间(PT)(WMD=0.85,95%CI:0.07～1.63,P<0.001)、纤维蛋白原(FIB)(WMD=0.24,95%CI:0.05～0.43,P<0.001)等。结论:LMWH联合硫酸镁对早发型重度子痫前期有较好的疗效。展开更多
Background Early onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, featu...Background Early onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, features, treatment, outcome and risk factors of early onset severe preeclampsia in Chinese women. Methods Four hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows： group A （less than 32 weeks, 73 cases）, group B ,（between 32 and 34 weeks, 71 cases）, and group C （greater than 34 weeks, 269 cases）. The demographic characteristics of the subjects, complications, delivery modes and outcome of pregnancy were analyzed retrospectively. Results The systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B, prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B. Liver and kidney dysfunction, pleural and peritoneal effusion, placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups. Twenty-four-hour urine protein levels at admission, intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia. Gestational week at admission and delivery week were also risk factors that affected perinatal outcome. Conclusions Early onset severe preeclampsia should be defined as occurring before 34 weeks, and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks. Independent risk factors should be used to tailor the optimized individual treatment plan, to balance both maternal and neonatal safety.展开更多
文摘目的:运用循证医学方法评价低分子肝素(LMWH)联合硫酸镁治疗早发型重度子痫前期的疗效。方法:计算机检索Cochrane Library、PubMed、Web of Science、CA、CNKI、万方等数据库并查阅检索到的纳入文献的参考文献,尽可能获取所有相关文献。制定严格的纳入和剔除标准,依据Cocharane手册5.1.0质量评价标准对纳入文献进行质量评价。采用Review Manager5.3软件进行meta分析。结果:最终纳入27篇RCT,共纳入2363例早发型重度子痫前期患者。meta分析结果显示,低分子肝素联合硫酸镁治疗能改善早发型重度子痫前期患者平均动脉压(MAP)[均数差(WMD)=-6.73,95%CI:-9.65～-3.81,P<0.001]、收缩压(SBP)(WMD=-6.46,95%CI:-12.33～-0.58,P<0.001)、舒张压(DBP)(WMD=-6.01,95%CI:-8.34～-3.68,P<0.001)、24h尿蛋白(WMD=-0.87,95%CI:-1.22～-0.53,P<0.001)、24h尿量(WMD=640.14,95%CI:301.06～979.22,P<0.001)、血小板计数(PLT)(WMD=3.61,95%CI:1.44～5.79,P=0.71)、活化部分凝血酶时间(APTT)(WMD=2.20,95%CI:0.94～3.46,P<0.001)、血红细胞压积(HCT)(WMD=-1.36,95%CI:-1.62～-1.10,P<0.001)、凝血酶原时间(PT)(WMD=0.85,95%CI:0.07～1.63,P<0.001)、纤维蛋白原(FIB)(WMD=0.24,95%CI:0.05～0.43,P<0.001)等。结论:LMWH联合硫酸镁对早发型重度子痫前期有较好的疗效。
文摘Background Early onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, features, treatment, outcome and risk factors of early onset severe preeclampsia in Chinese women. Methods Four hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows： group A （less than 32 weeks, 73 cases）, group B ,（between 32 and 34 weeks, 71 cases）, and group C （greater than 34 weeks, 269 cases）. The demographic characteristics of the subjects, complications, delivery modes and outcome of pregnancy were analyzed retrospectively. Results The systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B, prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B. Liver and kidney dysfunction, pleural and peritoneal effusion, placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups. Twenty-four-hour urine protein levels at admission, intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia. Gestational week at admission and delivery week were also risk factors that affected perinatal outcome. Conclusions Early onset severe preeclampsia should be defined as occurring before 34 weeks, and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks. Independent risk factors should be used to tailor the optimized individual treatment plan, to balance both maternal and neonatal safety.
