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目的观察低分子肝素钙注射液联合丹参注射液治疗早发型重度子痫前期的临床效果。方法选择2010年6月—2012年6月收治的早发型重度子痫前期患者96例,随机分为丹参组33例、低分子肝素钙组32例和联合组31例。所有患者均给予常规治疗,丹参组加用丹参注射液16 ml加入5%葡萄糖注射液250 ml,静脉滴注,1次/d,连用14 d。低分子肝素钙组加用低分子肝素钙4 100 U,腹部皮下注射,2次/d,连用5 d。联合组同时加用低分子肝素钙注射液和丹参注射液,用法与用量、使用时间同丹参组、低分子肝素钙组。对比三组血浆粘度变化、血浆D-二聚体变化及妊娠结局、主要并发症、新生儿情况。计量资料比较采用方差分析,组间两两比较采用LSD-t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果治疗后,丹参组血浆粘度、D-二聚体分别为(1.6±0.3)m Pa·s、(1.8±0.4)mg/L,丹参组分别为(1.7±0.3)m Pa·s、(1.9±0.5)mg/L,低分子肝素钙组分别为(1.2±0.2)m Pa·s、(1.5±0.2)mg/L,联合组与丹参组、低分子肝素钙组比较差异均有统计学意义(均P<0.05)。丹参组、低分子肝素钙组、联合组延长孕周分别为(8.5±2.0)、(8.2±1.8)、(11.4±1.5)d,联合组与丹参组、低分子肝素钙组比较差异均有统计学意义(均P<0.05)。丹参组胎儿窘迫发生率为51.5%,低分子肝素钙组为53.1%,联合组为29.0%,联合组与丹参组、低分子肝素钙组比较差异均有统计学意义(均P<0.05)。丹参组胎龄、新生儿体重分别为(31.0±1.3)周、(1.9±0.2)kg,低分子肝素钙组分别(31.3±1.5)周、(1.8±0.3)kg,联合组分别为(33.4±1.4)周、(2.1±0.3)kg,联合组与丹参组、低分子肝素钙组比较差异均有统计学意义(均P<0.05)。丹参组新生儿出生后1 min Apgar评分≥7分的比例为57.6%,联合组为80.6%,两组比较差异有统计学意义(P<0.05)。丹参组新生儿死亡发生率为30.3%,低分子肝素钙组为28.1%,联合组为9.7%,比较差异均有统计学意义(均P<0.05)。结论低分子肝素钙注射液联合丹参注射液治疗早发型重度子痫前期,可有效改善患者机体高凝状态,延长孕周,增加胎儿体重,增加新生儿成活率,改善妊娠结局,可作为早发型重度子痫前期的有效治疗方法。
Objective To observe the clinical effect of low molecular weight heparin injection combined with Salvia miltiorrhiza injection on early-onset severe preeclampsia. Methods Ninety-six patients with early-onset severe preeclampsia who were admitted from June 2010 to June 2012 were randomly divided into three groups: 33 in Salvia miltiorrhiza, 32 in low molecular weight heparin group and 31 in combination group. All patients were given conventional treatment. Salviae miltiorrhizae group added with Danshen injection 16 ml 5% glucose injection 250 ml, intravenous infusion, 1 / d, once every 14 d. Low molecular weight heparin group with low molecular weight heparin calcium 4 100 U, abdominal subcutaneous injection, 2 times / d, once every 5 d. Combination group also added low molecular weight heparin injection and Salvia injection, usage and dosage, the use of time with the Salvia group, low molecular weight heparin group. The changes of plasma viscosity, plasma D-dimer, pregnancy outcome, major complications and newborns were compared. Measurement data were compared using ANOVA, LSD-t test was used to compare the pairwise comparisons between two groups, and the count data was analyzed byχ2 test. P <0.05 was considered statistically significant. Results After treatment, the plasma viscosity and D-dimer were (1.6 ± 0.3) mPa · s and (1.8 ± 0.4) mg / L in Danshen group and (1.7 ± 0.3) mPa · s and 1.9 ± 0.5) mg / L, low molecular weight heparin group was (1.2 ± 0.2) m Pa · s and (1.5 ± 0.2) mg / L, respectively. There were statistics differences between the combined group and the Salvia miltiorrhiza group and low molecular weight heparin group Significance (both P <0.05). Salvia miltiorrhiza, low molecular weight heparin group and combined group were (8.5 ± 2.0), (8.2 ± 1.8) and (11.4 ± 1.5) d, respectively. There were significant differences between the combined group and the Salvia miltiorrhiza group and low molecular weight heparin group Statistical significance (all P <0.05). The incidence of fetal distress was 51.5% in Salvia miltiorrhiza, 53.1% in low-molecular-weight heparin group and 29.0% in combination group. There was significant difference between combined group and Salvia miltiorrhiza group and low-molecular-weight heparin group (all P <0.05). The gestational age and neonatal weight of Salvia miltiorrhiza group were (31.0 ± 1.3) weeks and (1.9 ± 0.2) kg respectively, and those in low molecular weight heparin group were (31.3 ± 1.5) weeks and (1.8 ± 0.3) ± 1.4 weeks, and (2.1 ± 0.3) kg respectively. There were significant differences between the combination group and the Salvia miltiorrhiza group and the low molecular weight heparin group (all P <0.05). The ratio of Apgar score ≥7 points at 1 min after birth in Salvia miltiorrhiza group was 57.6%, and the combined group was 80.6%. There was significant difference between the two groups (P <0.05). The incidence of neonatal death was 30.3% in Salvia miltiorrhiza, 28.1% in low molecular weight heparin group and 9.7% in combined group (all P <0.05). Conclusions Low molecular weight heparin injection combined with Salvia miltiorrhiza injection in the treatment of early-onset severe preeclampsia can effectively improve the hypercoagulability, prolong the gestational age, increase the fetal weight, increase the neonatal survival rate and improve the pregnancy outcome, which can be used as early-onset Severe preeclampsia effective treatment.