硫酸镁联合低分子肝素治疗早发型子痫前期的病例对照研究  

A case-control study on magnesium sulfate combining low molecular weight heparin treatment of early-onset preeclampsia

作　　者：肖立[1] 李智泉[1] 周紫琼 冷灵芝[1] 

机构地区：[1]深圳市妇幼保健院,广东深圳518028

出　　处：《热带医学杂志》2012年第7期857-860,共4页Journal of Tropical Medicine

摘　　要：目的探讨硫酸镁联合低分子肝素治疗早发型子痫前期的疗效及其妊娠结局。方法将50例早发型子痫前期患者分为硫酸镁治疗组(n=22)和硫酸镁联合低分子肝素治疗组(n=28),并进行病例对照分析,观察治疗前后的凝血功能、肾功能变化及妊娠结局。结果两组患者治疗后收缩压及舒张压均明显下降,但下降幅度差异无统计学意义(P>0.05)。排除治疗前凝血功能或肾功能基础值的影响,硫酸镁联合低分子肝素治疗使凝血酶原时间(PT)明显延长、凝血酶原时间国际标准化比值(PT-INR)明显增大、凝血酶时间(TT)明显延长,差异有统计学意义(P<0.05),但上述各指标改变后仍在正常范围以内。硫酸镁联合低分子肝素治疗对尿蛋白及血尿酸的减少影响更显著,差异有统计学意义(P<0.05)。两个治疗组之间的血清尿素氮和血清肌酐的变化差异无统计学意义(P>0.05)。两组之间的分娩孕周、期待治疗时间、新生儿体重及新生儿出生Apgar评分及母儿并发症发生率差异均无统计学意义(P>0.05)。结论在传统治疗的基础上加用低分子肝素辅助治疗早发型子痫前期是安全的,且可以对肾功能起到保护作用,明显减少尿蛋白量。尚未观察到低分子肝素对妊娠结局的影响。Objective To investigate the effect of magnesium sulfate combining with low molecular weight heparin （LMWH, nadroparin） on early-onset preeclampsia and analyze their pregnancy outcomes. Methods Case-control analysis of 50 cases admitted to hospital from April 2009 to October 2009 with early-onset preeclampsia was performed. They were divided into two treatment groups： Group 1 （treated with magnesium sulfate, n=22）, and Group 2 （treated with magnesium sulfate combined with low molecular heparin, n=28）. The changes in coagulation, renal function before and after treatment and their pregnancy outcome were observed. Results After treatment, systolic and diastolic blood pressure of the two groups both decreased, but the decline was not significant （/9〉0.05）. Exclude the effect of basic value before treatment, the prothrombin time （PT） and thrombin time （TF） are both significantly prolonged and prothrombin time international ratio （PT-INR） was significantly increased in the second group, and the difference was statistically significant （P〈0.05）, but each of these indicators are still within the normal range. Urine protein and serum uric acid reduced more significant in the second group compared with the first group （P〈0.05）. Changes between the two groups in serum urea nitrogen and serum creatinine showed no significant difference （P〉0.05）. Between the two groups, gestational age, expectant treatment time, birth weight and birth Apgar score and the incidence rate of maternal and fetal complications showed no significant difference （P〉0.05）. Conclusion On the basis of traditional treatment, low molecular weight heparin for secondary treatment of early-onset preeclampsia is safe and can play a protective effect on renal function, significantly reducing the amount of urinary protein. The impact of low molecular weight heparin on pregnancy outcomes has not been observed.

关 键 词：早发型子痫前期 硫酸镁 低分子肝素 

分 类 号：R714.245[医药卫生—妇产科学]