肝素治疗胎儿生长受限的临床观察  

Effect of heparin on fetal growth restriction

作　　者：余艳红 沈立勇[1] 钟梅[1] 张宇[2] 苏桂栋[1] 高云飞[1] 全松[1] 曾莉 

机构地区：[1]第一军医大学南方医院妇产科,广州510515 [2]解放军第五三六医院妇产科

出　　处：《中华妇产科杂志》2004年第12期793-796,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：广东省重大社会问题联合攻关课题基金资助项目 (2KB0 470 1S)

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 10 7例FGR患者分为 3组 ,标准肝素治疗组 37例 ,将标准肝素 5 0～ 75mg溶于 5 %葡萄糖氯化钠注射液 5 0 0ml中静脉滴注 ,6～ 8h滴完 ;低分子肝素治疗组 31例 ,给予低分子肝素 (商品名 :速避凝 ) 0 2～ 0 4ml皮下注射 ;对照组 39例 ,给予低分子右旋糖酐 5 0 0ml加复方丹参注射液 2 0ml静脉滴注。治疗前后及终止妊娠前 ,行彩色超声 (彩超 )检查 ,监测胎儿生长情况和脐血流变化 ,并进行生物物理评分 ,同时监测血小板计数 (PLT)、凝血酶原时间 (PT)、部分凝血活酶时间 (APTT) ;记录新生儿情况并进行随访。结果　 (1)标准肝素治疗组、低分子肝素治疗组 ,平均每周宫高均增长 (0 7± 0 6 )cm ,高于对照组的(0 5± 0 4 )cm ,差异有显著性 (P <0 0 5 ) ;平均每周双顶径分别增长 [(2 4± 0 7)mm、(2 5± 0 8)mm ,显著高于对照组的 (1 7± 0 6 )mm ,差异也有显著性 (P <0 0 5 )。 (2 )标准肝素治疗组、低分子肝素治疗组、对照组胎儿生物物理评分别为 (9 7± 0 8)分、(9 6± 0 6 )分、(8 9± 0 7)分 ,差异有显著性(P <0 0 5 )。 (3)标准肝素治疗组及低分子肝素治疗组 ,脐动脉收缩期最大血流速度 (S)与舒张末期血流速度 (D)?Objective To investigate the clinical effect and safety of heparin in treating fetal growth restriction (FGR) Methods A total of 107 women diagnosed with FGR were randomized into three groups Group 1 (standard heparin group, n =37) received 50 75 mg standard heparin added to 500 m1 5% glucose sodium chloride, infused intravenously in 6 8 hours Group 2 (low molecular weight heparin group, n =31) received 0 2 0 4 ml low molecular weight heparin given by subcutaneous injection Control group ( n =39) received 20ml dan shen added to 500 ml low molecular weight dextran infused intravenously Fetal growth indices, biophysical score,umbilical artery blood flow, count of platelet(PLT), prothrombin time(PT),activated partial thromboplastin time (APTT), 1 minute Apgar score, body weight and gestational age of the neonates were measured Babies prognosis was followed up Results (1)Height of fundus of uterus was obviously increased per week in the groups of standard heparin (0 7±0 6) cm and low molecular weight heparin [(0 7±0 6) cm] vs control group [(0 5±0 4)cm , P <0 05] Biparietal diameter of fetus increased in standard heparin [(2 4±0 7)mm] and low molecular weight heparin [(2 5± 0 8) mm] groups vs control [(1 7±0 6) mm , P <0 05] The femur length, head circumference and abdominal circumference of fetus were significantly longer in heparin treated patients than in control group ( P <0 05) (2)Biophysical score improved in groups of standard heparin (9 7±0 8) and low molecular weight heparin (9 6±0 6) vs control group (8 9±0 7) ( P <0 05) (3)Umbilical blood S/D ratio decreased in standard heparin (2 5±0 5) and low molecular weight heparin(2 4±0 5) groups vs control group(2 9±0 6) ( P <0 05) Pulsatile index (PI) and resistance index (RI) were significantly lower also ( P <0 05) (4)Rate of one minute Apgar score ( 8 10) was 86% in group 1, 87% in group 2 and 74% in control group, respectively Body weight

关 键 词：治疗组 对照组 低分子肝素 新生儿 治疗前后 生物物理评分 足月小样儿 显著性 记录 PLT 

分 类 号：R714.5[医药卫生—妇产科学]