早期妊娠重度绒毛膜下血肿患者病因探讨及个体化治疗效果研究  

The etiology of severe subchorionic hematoma in the first trimester of pregnancy and the effect of individual therapy

作　　者：胡慧[1] 胡春花[1] 何培芝[1] 王萍[1] HU Hui;HU Chunhua;HE Peizhi;WANG Ping(Department of Gynecology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,P.R.China)

机构地区：[1]上海中医药大学附属曙光医院妇科,上海200021

出　　处：《中国计划生育和妇产科》2020年第8期33-38,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：上海中医药大学预算内项目(项目编号:2019LK017)。

摘　　要：目的探讨早孕期合并重度绒毛膜下血肿(subchorionic hematoma,SCH)的先兆流产患者子宫动脉血流(uterine artery blood flow,UtA)变化、病因及具体治疗方案的有效性和安全性。方法选择2018年1月至2019年12月在上海中医药大学附属曙光医院诊断为重度SCH的早孕期先兆流产患者30例为研究组,正常早孕期妇女30例为对照组。观察比较两组患者UtA变化,并对研究组进行自身免疫指标、获得性血栓前状态、相关内分泌功能检测,探讨SCH患者的病因。针对研究组患者可能病因及有无活动性出血制订个体化治疗方案进行治疗,比较治疗前后血肿大小、UtA值,观察早期妊娠结局和安全性指标。结果①研究组双侧阻力指数(resistance index,RI)、搏动指数(pulsatility index,PI)、收缩期峰值流速/舒张末期流速(systolic peak velocity/end diastolic velocity,S/D)之和均高于对照组[(1.73±0.09)、(4.10±0.82)、(17.24±4.82)vs(1.48±0.12)、(3.03±0.44)、(9.34±1.74)],差异有统计学意义(P<0.05)。②研究组患者治疗后双侧RI、PI、S/D和较治疗前下降,SCH缩小[3.60(4.29)cm3 vs 0.00(0.74)cm3],差异有统计学意义(P<0.05)。治疗后孕12周内SCH完全消退者20例(66.7%)。③研究组治疗后早孕期保胎成功27例(90.0%);流产3例(10.0%)。④研究组30例患者中自身免疫异常者9例(30.0%),获得性血栓前状态21例(70.0%),内分泌异常13例(43.3%)。⑤研究组治疗后未发生血小板下降、凝血机制异常等不良反应;肝功能轻度异常4例,肝功能中度异常1例,肝功能损害发生率16.7%;过敏性皮疹1例,发生率3.3%;上述各种异常情况经处理后均消失。结论重度SCH患者存在UtA异常,自身免疫异常、获得性血栓前状态、内分泌异常的发生率高于文献报道复发性流产相关病因的发生率。诊治SCH过程中应重视此类病因筛查。根据重度SCH患者病因及有无活动性出血实施个体化治疗方案,能够有效改善保胎效�Objective To study the changes and causes of uterine artery blood flow(UtA)of threatened abortion patients with severe subchorionic hematoma(SCH)in first trimester and efficacy and safety of individualized treatment.Methods 30 patients diagnosed as threatened abortion with severe SCH in first trimester in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2018 to December 2019 were selected as the study group and 30 normal pregnant women in first trimester as the control group.The changes of UtA in the two groups were observed.The autoimmunity disorder,acquired prethrombus status and related endocrine function in study group were examined to investigate the causes of SCH.According to the possible etiology of the patients in the study group and the presence or absence of active bleeding,an individualized treatment plan was developed for treatment.The hematoma size and UtA value before and after treatment were compared,and early pregnancy outcomes and safety indicators were observed.Results①Bilateral resistance index(RI),pulsatility index(PI),systolic peak velocity/end diastolic velocity(S/D)in the study group were higher than the control group[(1.73±0.09),(4.10±0.82),(17.24±4.82)vs(1.48±0.12),(3.03±0.44),(9.34±1.74)],the differences were statistically significant(P<0.05).②The RI,PI and S/D of the two sides of the patients in the study group after treatment were significantly lower than those before treatment,SCH reduction[3.60(4.29)cm3 vs 0.00(0.74)cm3],the differences were statistically significant(P<0.05).SCH in 20 patients were completely absorbed within 12 weeks after treatment.③27 cases of threatened abortion were cured in first trimester in the study group(90.0%).The abortion rate was 10.0%.④9 cases in the study group had abnormal autoimmunity with an incidence of 30.0%,21 had acquired prethrombus status with an incidence of 70.0%,and 13 had endocrine abnormalities with an incidence of 43.3%.⑤No adverse reactions such as decreased platelet and oth

关 键 词：绒毛膜下血肿 子宫动脉血流 低分子肝素 中药 

分 类 号：R714.2[医药卫生—妇产科学]