依诺肝素加阿司匹林在预防高危产妇子痫前期中的应用价值  

Enoxaparin plus aspirin in prevention of preeclampsia in high-risk pregnant women

作　　者：张红莉[1] 南刚[1] 李丽春[1] ZHANG Hongli;NAN Gang;LI Lichun(Department of Obstetrics and Gynecology,Affiliated Hospital of Yan'an University,Yan'an 716000,Shaanxi Province,China)

机构地区：[1]延安大学附属医院妇产科

出　　处：《解放军医学院学报》2019年第8期760-763,共4页Academic Journal of Chinese PLA Medical School

基　　金：延安市科技局科技惠民计划项目(2015HM-01-01)~~

摘　　要：目的联合依诺肝素与阿司匹林用于合并高危因素产妇子痫前期的预防,探讨依诺肝素的应用价值。方法采用前瞻性队列研究,以延安大学附属医院2016年6月-2018年6月建档的子痫前期高危因素产妇作为研究对象,根据子痫前期的预防方法分为观察组(101例,使用依诺肝素加阿司匹林)和对照组(104例,仅使用阿司匹林),比较两组产妇子痫前期发生情况及妊娠结局。结果观察组重度子痫前期发生率低于对照组[36例(35.6%)vs 45例(43.3%),P=0.034],开始进行子痫治疗的时间晚于对照组[(31.9±4.3)周vs(30.6±4.7)周,P=0.040];两组子痫前期发生率差异无统计学意义(P=0.264)。观察组早产率低于对照组[24例(23.8%)vs41例(39.4%),P=0.016],用药不良反应发生率高于对照组[13例(12.9%)vs 4例(3.8%),P=0.019];两组终止妊娠时间、胎儿生长受限和胎盘早剥发生情况的差异无统计学意义(P均>0.05)。观察组新生儿转NICU率低于对照组[18例(17.8%)vs 33例(31.7%),P=0.021];两组新生儿出生体质量和窒息情况差异均无统计学意义(P均>0.05)。结论与仅使用阿司匹林相比,依诺肝素联合阿司匹林能够有效降低重度子痫前期发生率,推迟子痫前期治疗干预时间并降低早产率,同时能够降低新生儿转NICU率。Objective To explore the value of enoxaparin in preventing preeclampsia in high-risk pregnant women.Methods A prospective cohort study was performed in pregnant women with high risk factors associated with preeclampsia from June 2016 to June 2018 in the Affiliated Hospital of Yan’an University.All patients were assigned into two groups according to the preventive treatment method.The observation group(n=101)received enoxaparin plus aspirin,while the control group(n=104)received aspirin alone.The incidence of preeclampsia and pregnancy outcomes were compared between the two groups.Results The incidence of severe preeclampsia in the observation group was lower than that in the control group[36 cases(35.6%)vs 45 cases(43.3%),P=0.034],and the initiation of preeclampsia treatment was later[(31.9±4.3)weeks vs(30.6±4.7)weeks,P=0.040].There was no significant difference in the incidence of preeclampsia between the two groups(P=0.264).Compared with the control group,the premature delivery rate of the observation group was lower[24 cases(23.8%)vs 41 cases(39.4%),P=0.016],while the incidence of adverse reactions was higher[13 cases(12.9%)vs 4 cases(3.8%),P=0.019].There was no significant difference in the time of pregnancy termination,the incidence of fetal growth restriction and placental abruption between the two groups(all P>0.05).In the observation group,the NICU transfer rate was less than that in the control group[18 cases(17.8%)vs 33 cases(31.7%),P=0.021].Conclusion Compared with use of aspirin alone,enoxaparin plus aspirin can effectively reduce the incidence of severe preeclampsia,delay the intervention,decrease the preterm birth,and reduce the rate of NICU transfer.

关 键 词：子痫前期 预防 依诺肝素 阿司匹林 

分 类 号：R714.244[医药卫生—妇产科学]