临床医学论文-肝素治疗胎儿生长受限临床应用探讨

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1、临床医学论文•肝素治疗胎儿生长受限临床应用探讨【摘要】口的:探讨肝素用于治疗胎儿生长受限(FGR)的临床疗效及安全性。方法:将74例胎儿生长受限患者随机分为3组，分别使用低分了右旋糖肝加复方丹参(对照组)、普通肝素(UFH)、低分子肝素(LMWH)治疗。治疗前、治疗后1周及终止妊娠前，行彩色超声检查，监测胎儿生长情况和脐血流变化，同时监测各项凝血指标，记录新生儿情况并进行随访。结果：(l)UFH组、LMWH组治疗后宫高、胎儿股骨长、头围、腹围增长值均高于对照组，差异有显着性(P<0・05),LMWH组胎儿双顶径增长显着高于对照组(P=0.031)°(2)两肝素组治疗后脐动脉收缩期最大血

2、流速度(S)与舒张末期血流速度(D)的比值(S/D比值)、搏动指数(PI)、阻力指数(RI)与对照组比较均明显降低，差异冇统计学意义(P<0.05),而两肝素组间比较无统计学差异(P>0.05)o(3)UFH组、LMWH组治疗后新生儿胎龄、出生体重、身长、胎盘重量均较对照组明显增加(P<0.05)，而两肝素组间无显着弟异(P>0.05)；新生儿窒息、胎死宫内、新生儿死亡发生率、早产发生率和新生儿畸形发生情况各组间无统计学差异(P>0.05)；对照组足月小样儿发生率明显高于两肝索组(P二().005),而肝索组之间则无显着差异(P>0.05)o对照组与LMWH相比，新生儿转重症监护病房(

3、NICU)几率明显升高(P二0.003)。(4)各组孕妇治疗前后各项凝血功能检测值比较，差异均无显着性(P>0.05),产后出血量及产后出血发生率相比茅异亦无统计学意义。结论:肝素可改善胎盘血流,使胎儿体重增加，减少足刀小样儿的发生率，口不增加产后出血发生机会，对母亲及胎儿都较安全。LWMH治疗FGR,新生儿转NICU几率明显低于对照组，效果优于普通肝素，且使用方便，产妇易于接受，更适于推广。【关键词】肝索肝索低分子量胎儿生长迟缓[ABSTRACT1Objective:Toanalyzetheclinicaleffectivenessandsafetyofheparinontheapp

4、licationoffetalgrowthrestriction(FGR)・Methods:74womendiagnosedwithFGRwereseparatedintothreegroupsrandomlywhichreceivedthetreatmentwithdanshenaddedlowmolecularweightdextran(controlgroup),unfractionated(UFH)heparinandlowmolecularweightheparin(LMWH).Thefetalgrowthindicesandtheumbi1icalarterybloodfl

5、owweredetectedbycoloredDopplerultrasoundjustbeforethetreatment,oneweekafterthetreatmentandbeforetheendingofpregnaney.Meanwhileitwasensuredthatcoagulationfunctionindiceswerewel1monitoredandtheprognosisofnewbornswascloselyfollowedup.Results:(1)InthegroupsofstandardheparinandLMWH,(heheightofuterine

6、fundus,thelengthoffetalthighbone,theheadcircumandtheabdominalcircumwereobviouslyincreasedaftertreatmentwithstatisticaldifference(P<0・05).Theincreaseofbipolardiameter(BPD)instandardheparingroupwasobviouslygreaterthanthatofthecontrolgroup(P二0・031)・(2)Comparedwiththeresultofcontrolgroup,theratioofu

7、mbi1icalmaximumbloodvelocityinsystolicphasetothatofdiastolicphase(S/D),pulseindex(Pl)andresistanceindex(RI)ofthetwoheparingroupswereobviouslydecreasedwithstatisticaldifference(Pv0・05)・However,thereisnostatisticaldifferencebe