肝素治疗胎儿生长受限临床应用探讨

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酐加复方丹参(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:(1)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,差异有显著性(P<0.05),LMWH组胎儿双顶径增长显著高于对照组(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)。(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>0.05)。对照组与LMWH相比,新生儿转重症监护病房(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。

Clinical Study on the Restriction of Heparin in Treating Fetal Growth

Objective:To analyze the clinical effectiveness and safety of heparin on the application of fetal growth restriction(FGR).Methods:74 women diagnosed with FGR were separated into three groups randomly which received the treatment with danshen added low-molecular-weight dextran(control group),unfractionated(UFH)heparin and low-molecular-weight-heparin(LMWH).The fetal growth indices and the umbilicalartery blood flow were detected by colored Doppler ultrasound just before the treatment,one week after the treatment and before the ending of pregnancy.Meanwhile it was ensured that coagulation function indices were well monitored and the prognosis of newborns was closely followed up.Results:(1)In the groups of standard heparin and LMWH,the height of uterine fundus,the length of fetal thigh bone,the head circum and the abdominal circum were obviously increased after treatment with statistical difference(P<0.05).The increase of bipolar diameter(BPD)in standard heparin group was obviously greater than that of the control group(P=0.031).(2)Compared with the result of control group,the ratio of umbilical maximum blood velocity in systolic phase to that of diastolic phase(S/D),pulse index(PI)and resistance index(RI)of the two heparin groups were obviously decreased with statistical difference(P<0.05).However,there is no statistical difference between the two heparin groups(P>0.05).(3)Compared with the control group,fetal age of newborns,birth weight,body length and placenta weight of standard heparin group and LMWH group were obviously increased with statistical difference(P<0.05).However,there is no statistical difference between the two heparin groups(P>0.05).As to the newborn asphyxia,dead fetus in uterus,newborn mortality,preterm birth morbidity and newborn malformation,there was no statistical difference among all groups(P<0.05).In the control group,the incidence of small for dated infant was obviously higher than that of two heparin groups(P=0.005),while there was no statistical difference between the two heparin groups(P>0.05).Compared with the LMWH group,the incidence of transportation to neonatal intensive care unit(NICU)was obviously higher in control group(P=0.003).(4)There was no statistical difference on coagulation function parameters and post partum bleeding morbidity among all groups before and after treatment(P>0.05).Conclusion:Heparin could improve the placenta blood flow and increase the fetal weight.It decreases the incidence of small for dated infant and does not increase the incidence of post partum bleeding.The incidence of transportation to NICU was obviously lower in the LMWH group than that of control group.LMWH is more effective and convenient than standard heparin and therefore can be accepted.