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目的探讨低分子肝素对胎儿生长受限(FGR)孕妇血栓前状态的影响,为其妊娠结局的改善提供参考依据。方法以2011年6月至2014年4月收治的78例FGR孕妇为研究对象,随机分为对照组(39例)和治疗组(39例)。对照组采用复方氨基酸、能量合剂及10%葡萄糖溶液静脉滴注;治疗组在对照组的基础上皮下注射低分子肝素0.3~0.4 ml/d。两组患者治疗1次/d,1周为1个疗程,隔1周进行下1个疗程,连续治疗2个疗程。观察并比较两组孕妇凝血功能及胎儿脐血血流状况、生长状况。结果对照组孕妇腹围、宫高增长情况明显低于治疗组(P<0.05,P<0.01);治疗组胎儿的头围、股骨长及双顶径生长状况显著高于对照组(P<0.05,P<0.01)。治疗后,两组胎儿的脐动脉血流收缩期最大血流速度与舒张末期血流速度比值(S/D)、阻力指数(RI)、搏动指数(PI)均出现不同程度降低,且治疗组治疗后S/D、RI、PI均低于对照组(P均<0.05)。两组治疗后血小板计数、凝血酶原时间均增高,且治疗组治疗后高于对照组(P<0.01,P<0.05);两组治疗后部分凝血活酶时间均增高,但差异无统计学意义(P>0.05)。结论低分子肝素对FGR孕妇血栓前状态有一定的改善作用,能促进胎儿生长,且用药相对安全。
Objective To investigate the effect of low molecular weight heparin on prothrombotic state of fetal growth restriction (FGR) in pregnant women and to provide reference for the improvement of pregnancy outcome. Methods 78 pregnant women with FGR admitted from June 2011 to April 2014 were randomly divided into control group (39 cases) and treatment group (39 cases). The control group received intravenous drip of compound amino acid, energy mixture and 10% glucose solution. The treatment group was injected subcutaneously with low molecular weight heparin 0.3-0.4 ml / d on the basis of the control group. Two groups of patients treated 1 / d, 1 week for a course of treatment, every 1 week for a course of treatment, continuous treatment of 2 courses. Observe and compare the coagulation function of pregnant women and fetal umbilical cord blood flow status and growth status. Results The growth rate of abdominal circumference and uterine height of pregnant women in control group was significantly lower than that in treatment group (P <0.05, P <0.01). The growth of head circumference, femur length and biparietal diameter in treatment group was significantly higher than that in control group (P <0.05 , P <0.01). After treatment, the umbilical artery systolic blood flow velocity and end-diastolic flow velocity ratio (S / D), resistance index (RI) and pulsatility index (PI) of the two groups of fetuses decreased to some extent, After treatment, S / D, RI, PI were lower than those in the control group (all P <0.05). After treatment, platelet count and prothrombin time were increased, and the treatment group was higher than the control group after treatment (P <0.01, P <0.05); both partial thromboplastin time after treatment increased, but the difference was not statistically significant Significance (P> 0.05). Conclusion Low molecular weight heparin can improve the prethrombotic state of FGR pregnant women and promote the growth of fetus, and the medication is relatively safe.