肝素治疗胎儿生长受限临床应用探析

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1、肝素治疗胎儿生长受限临床应用探析【摘要】目的：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，分别使用低分子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、腹围增长值均髙于对照组，差异有显著性(P<；O.05),LMWH组胎儿双顶径增长显著高于对照组(P=0.031)o(2)两肝素组治疗后脐动脉收缩期最大血流速度(S)与

2、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，差异有统计学意义(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),而两肝素组间无显著差异(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素组(p=0.005),而肝素组之间则无显著差异(P>；o.05)o对照组与LMWH相比，新生儿转

3、重症监护病房(NICU)几率明显升高(P=0.003)。(4)各组孕妇治疗前后各项凝血功能检测值比较，差异均无显著性(P>；0.05),产后出血量及产后出血发生率相比差异亦无统计学意义。结论：肝素可改善胎盘血流，使胎儿体重增加,减少足月小样儿的发生率，且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】肝素肝素低分子量胎儿生长迟缓[ABSTRACT]Objective：Toanalyzetheclinicaleffectivenessandsafetyofheparino

4、ntheapplicationoffetalgrowthrestriction(FGR)・Methods：74womendiagnosedwithFGRwereseparatedintothreegroupsrandomlywhichreceivedthetreatmentwithda.nshenaddedlowmolecularweightdextran(controlgroup),unfractionated(UFH)heparinandlowmolecularweightheparin(LMWH).Thefetalgrowthindicesandtheumbilicalarterybl

5、oodflowweredetectedbycoloredDopplerultrasoundjustbeforethetreatment,oneweekafterthetreatmentandbeforetheendingofpregnaney.Meanwhileitwasensuredthatcoagulationfunctionindiceswerewellmonitoredandtheprognosisofnewbornswascloselyfollowedup.Results：(1)InthegroupsofstandardheparinandLMWH,theheightofuteri

6、nefundus,thelengthoffetalthighbone,theheadcircumandtheabdominalcircumwereobviouslyincreasedaftertreatmentwithstatisticaldifference(P<；0.05).Theincreaseofbipolardiameter(BPD)instandardheparingroupwasobviouslygreaterthanthatofthecontrolgroup(P=0.031)・(2)Comparedwiththeresultofcontrolgroup,theratioo

7、fumbilicalmaximumbloodvelocityinsystoliephasetothatofdiastoliephase(S/D),pulseindex(PI)andresistanceindex(RI)ofthetwoheparingroupswereobviouslydecreasedwithstatisticaldifference(P<；0.05)・However,thereisno