丹参注射液联合肝素治疗胎儿生长受限的临床疗效及对孕妇血流变的影响
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摘要
目的:探讨丹参注射液联合肝素治疗胎儿生长受限(FGR)的临床疗效及对胎儿脐动脉血流及孕妇血流变的影响。方法:选取2014年8月至2016年4月新乡市中心医院收治FGR孕妇88例,随机分为观察组(n=44)和对照组(n=44)。对照组给予丹参联合右旋糖酐氨基酸治疗,观察组给予丹参联合低分子肝素钠治疗,1个疗程7 d,共治疗3个疗程。比较2组治疗前后胎儿生长情况及胎儿脐动脉血流;检测并比较2组孕妇凝血及血流变指标;统计2组新生儿情况及围产期并发症发生情况。结果:观察组胎儿双顶径、股骨长度、头围、腹围及宫高增长明显快于对照组(P<0.01)。观察组总有效率93.18%明显高于对照组的77.27%(P<0.05)。治疗后观察组PI、RI及S/D均较治疗前及对照组降低(P<0.01);对照组仅S/D降低(P<0.01)。与治疗前比较,治疗后2组PT、APTT明显延长,FIB、D-D水平、全血低切黏度、血浆黏度及红细胞压积明显降低(P<0.05或P<0.01);与对照组比较,观察组PT延长,FIB、D-D、全血低切黏度、血浆黏度及红细胞压积水平降低(P<0.05或P<0.01)。与对照组比较,观察组新生儿娩出胎龄延长,出生体重、身长及1 min Apgar评分明显升高(P<0.05或P<0.01)。结论:丹参注射液联合肝素治疗妊娠中晚期FGR可显著促进胎儿生长,改善胎儿脐血流及孕妇血流变指标,疗效确切,具有一定的临床应用价值。
Objective: To investigate the effect of salvia miltiorrhiza injection combined with heparin on fetal growth restriction( FGR) and on fetal umbilical artery blood flow and maternal blood rheology. Methods: All 88 patients with FGR who were in our hospital from August 2014 to April 2016 were randomly divided into an observation group( n = 44) and a control group( n = 44).The control group were treated with salvia miltiorrhiza combined with dextran amino acid,the observation group salvia miltiorrhiza combined with low molecular weight heparin sodium,and 1 course was 7 days,2 groups treated for 3 courses. The fetal growth and umbilical artery blood flow were compared between 2 groups before and after treatment; the blood coagulation and hemorheology indexes of 2 groups were detected and compared; the newborns and perinatal complications of 2 groups were statistically analyzed.Results: The growth of fetal biparietal diameter,head circumference,abdominal circumference and femur length,uterine height in observation group was significantly faster than that of the control group( P < 0. 01). The total effective rate of the observation group was 93. 18%,which was higher than that,77. 27%,of the control group( P < 0. 05). After treatment,the PI,RI and S/D in observation group were lower than those before treatment and control group( P < 0. 01),and in control group,only S/D decreased( P < 0. 01). Compared with before treatment,PT and APTT were significantly prolonged,FIB,D-D,whole blood low shear viscosity,plasma viscosity and hematocrit were significantly decreased in 2 groups( P < 0. 05 or P < 0. 01). Compared with the control group,PT in observation group prolonged,FIB,D-D,whole blood low shear viscosity,plasma viscosity and hematocrit decreased( P < 0. 05 or P < 0. 01). Compared with the control group,the gestational age of the neonates was prolonged,the birth weight,body length and 1 min Apgar score were significantly higher in observation group( P < 0. 05 or P < 0. 01). Conclusion:Salvia miltiorrhiza injection combined with heparin can improve fetal growth,improve fetal umbilical blood flow and maternal rheological parameters in the middle and late pregnancy. The curative effect is definite and has certain clinical application value.
Objective: To investigate the effect of salvia miltiorrhiza injection combined with heparin on fetal growth restriction( FGR) and on fetal umbilical artery blood flow and maternal blood rheology. Methods: All 88 patients with FGR who were in our hospital from August 2014 to April 2016 were randomly divided into an observation group( n = 44) and a control group( n = 44).The control group were treated with salvia miltiorrhiza combined with dextran amino acid,the observation group salvia miltiorrhiza combined with low molecular weight heparin sodium,and 1 course was 7 days,2 groups treated for 3 courses. The fetal growth and umbilical artery blood flow were compared between 2 groups before and after treatment; the blood coagulation and hemorheology indexes of 2 groups were detected and compared; the newborns and perinatal complications of 2 groups were statistically analyzed.Results: The growth of fetal biparietal diameter,head circumference,abdominal circumference and femur length,uterine height in observation group was significantly faster than that of the control group( P < 0. 01). The total effective rate of the observation group was 93. 18%,which was higher than that,77. 27%,of the control group( P < 0. 05). After treatment,the PI,RI and S/D in observation group were lower than those before treatment and control group( P < 0. 01),and in control group,only S/D decreased( P < 0. 01). Compared with before treatment,PT and APTT were significantly prolonged,FIB,D-D,whole blood low shear viscosity,plasma viscosity and hematocrit were significantly decreased in 2 groups( P < 0. 05 or P < 0. 01). Compared with the control group,PT in observation group prolonged,FIB,D-D,whole blood low shear viscosity,plasma viscosity and hematocrit decreased( P < 0. 05 or P < 0. 01). Compared with the control group,the gestational age of the neonates was prolonged,the birth weight,body length and 1 min Apgar score were significantly higher in observation group( P < 0. 05 or P < 0. 01). Conclusion:Salvia miltiorrhiza injection combined with heparin can improve fetal growth,improve fetal umbilical blood flow and maternal rheological parameters in the middle and late pregnancy. The curative effect is definite and has certain clinical application value.
引文
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[11]吴婷,罗力冰.低分子肝素对胎儿生长受限孕妇血栓前状态的改善作用[J].中国临床研究,2015,28(3):353-355.
[12]郭珍,温丽,胡际东,等.低分子肝素对子痫前期合并FGR孕妇HO-1及胎盘质量的影响[J].西南国防医药,2015,25(12):1323-1325.
[13]Pecks U,Brieger M,Schiessl B,et al.Maternal and fetal cord blood lipids in intrauterine growth restriction.[J].Journal of Perinatal Medicine,2015,40(3):287-296.
[14]吕新华,王红飞.彩超检测在妊娠高血压综合征合并胎儿生长受限胎儿肾动脉血流参数中的应用价值[J].医药卫生:文摘版,2016,2(4):283.
[15]黄月婷,张建平.妊娠合并症及并发症与血液指标异常的观察与处理[J].实用妇产科杂志,2016,32(9):655-658.
[16]石中华,丁虹娟.妊娠合并血小板减少的病因及诊疗策略[J].实用妇产科杂志,2016,32(9):649-652.
[17]章茜,姜纬.低分子肝素联合低分子右旋糖酐治疗胎儿宫内生长受限的效果观察[J].山东医药,2014,54(45):73-74.
[18]Wang Q.Efficacy of low molecular heparin in the treatment of fetal growth restriction[J].Jiangsu Medical Journal,2011,37(18):2154-2156.
[19]李焕君.硫酸镁联合复方丹参注射液、川芎注射液治疗妊高症的效果对比[J].实用妇科内分泌杂志(电子版),2016,3(2):95-96.
[20]王韫琪,向丽娟,刘英莲.复方丹参注射液联合低分子肝素和硝苯地平治疗子痫前期的临床疗效研究[J].中国临床药理学杂志,2016,32(8):681-683.
[2]Maitre L,Fthenou E,Athersuch T,et al.Urinary metabolic profiles in early pregnancy are associated with preterm birth and fetal growth restriction in the Rhea mother-child cohort study[J].BMC Medicine,2014,12(1):110.
[3]周晓玲,李俊芹,周巧兰.低分子肝素联合低分子右旋糖酐在胎儿生长受限治疗中的临床应用价值分析[J].现代预防医学,2012,39(2):332-332,339.
[4]乐杰.妇产科学[M].7版.北京:人民卫生出版社,2008:67.
[5]Macdonald T M,Mccarthy E A,Walker S P.Shining light in dark corners:diagnosis and management of late-onset fetal growth restriction[J].Australian&New Zealand Journal of Obstetrics&Gynaecology,2015,55(1):3-10.
[6]Blair E M,Nelson K B.Fetal growth restriction and risk of cerebral palsy in singletons born after at least 35 weeks'gestation[J].American Journal of Obstetrics&Gynecology,2015,212(4):1-7.
[7]Lewis A J,Austin E,Galbally M.Prenatal maternal mental health and fetal growth restriction:a systematic review[J].Journal of Developmental Origins of Health&Disease,2016,7(4):1.
[8]徐月英,张慧娟,吴维宾,等.特发性胎儿生长受限胎盘组织学与体视学分析[J].实用妇产科杂志,2016,32(4):298-302.
[9]钟湘平.硫酸镁与丹参在胎儿生长受限中的疗效分析[J].中外医学研究,2014,12(13):51-52.
[10]向萍.黄芪联合丹参注射液治疗重度子痫前期合并胎儿生长受限中的临床效果观察[J].中国医药指南,2014,12(23):265-266.
[11]吴婷,罗力冰.低分子肝素对胎儿生长受限孕妇血栓前状态的改善作用[J].中国临床研究,2015,28(3):353-355.
[12]郭珍,温丽,胡际东,等.低分子肝素对子痫前期合并FGR孕妇HO-1及胎盘质量的影响[J].西南国防医药,2015,25(12):1323-1325.
[13]Pecks U,Brieger M,Schiessl B,et al.Maternal and fetal cord blood lipids in intrauterine growth restriction.[J].Journal of Perinatal Medicine,2015,40(3):287-296.
[14]吕新华,王红飞.彩超检测在妊娠高血压综合征合并胎儿生长受限胎儿肾动脉血流参数中的应用价值[J].医药卫生:文摘版,2016,2(4):283.
[15]黄月婷,张建平.妊娠合并症及并发症与血液指标异常的观察与处理[J].实用妇产科杂志,2016,32(9):655-658.
[16]石中华,丁虹娟.妊娠合并血小板减少的病因及诊疗策略[J].实用妇产科杂志,2016,32(9):649-652.
[17]章茜,姜纬.低分子肝素联合低分子右旋糖酐治疗胎儿宫内生长受限的效果观察[J].山东医药,2014,54(45):73-74.
[18]Wang Q.Efficacy of low molecular heparin in the treatment of fetal growth restriction[J].Jiangsu Medical Journal,2011,37(18):2154-2156.
[19]李焕君.硫酸镁联合复方丹参注射液、川芎注射液治疗妊高症的效果对比[J].实用妇科内分泌杂志(电子版),2016,3(2):95-96.
[20]王韫琪,向丽娟,刘英莲.复方丹参注射液联合低分子肝素和硝苯地平治疗子痫前期的临床疗效研究[J].中国临床药理学杂志,2016,32(8):681-683.