低分子肝素联合地屈孕酮治疗先兆流产合并宫腔积血的临床疗效  

Clinical effect of low molecular weight heparin combined with dydrogesterone in the treatment of threatened abortion complicated with intrauterine hematocele

作　　者：杨华琴 王英 戴美红 罗琼[1] YANG Huaqin;WANG Ying;DAI Meihong;LUO Qiong(Three Branches of Obstetrics,Women’s Hospital School of Medicine Zhejiang University,Hangzhou 310006,Zhejiang,China;Department of Gynecology,Taizhou Central Hospital(Taizhou University Hospital),Taizhou 318000,Zhejiang,China;Department of Pharmacy,Taizhou Central Hospital(Taizhou University Hospital),Taizhou 318000,Zhejiang,China)

机构地区：[1]浙江大学医学院附属妇产科医院产三科,浙江杭州310006 [2]台州市中心医院(台州学院附属医院)妇科,浙江台州318000 [3]台州市中心医院(台州学院附属医院)药剂科,浙江台州318000

出　　处：《中国现代医生》2023年第13期8-11,30,共5页China Modern Doctor

基　　金：浙江省卫生健康重大科技计划项目(WKJ-ZJ-2126)。

摘　　要：目的分析低分子肝素联合地屈孕酮治疗先兆流产合并宫腔积血的临床疗效。方法选取2021年3月至2022年3月浙江大学医学院附属妇产科医院收治的80例先兆流产合并宫腔积血患者为研究对象,根据随机数字表法将其分为对照组和研究组,每组各40例。对照组患者采用地屈孕酮治疗,研究组患者在对照组的基础上使用低分子肝素治疗,比较两组患者治疗前后的激素水平、凝血–纤溶指标、炎症因子水平和超声参数,记录两组患者的妊娠成功率和不良反应发生率。结果治疗后,两组患者的孕酮、人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)、雌二醇(estradiol,E2)、收缩期峰值流速(peak systolic velocity,PSV)、舒张末期流速(end diastolic velocity,EDV)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、白细胞介素(interleukin,IL)-4、IL-10均显著高于本组治疗前,血肿面积、动脉阻力指数(resistance index,RI)、纤维蛋白原(fibrinogen,FIB)、D二聚体(D-dimer,D-D)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)均显著低于本组治疗前(P<0.05),且研究组患者的孕酮、HCG、E2、PSV、EDV、PT、APTT、IL-4、IL-10均显著高于对照组,血肿面积、动脉RI、FIB、D-D、TNF-α均显著低于对照组(P<0.05);研究组患者的妊娠成功率显著高于对照组(χ^(2)=4.501,P=0.034);两组患者的不良反应发生率比较无统计学意义(χ^(2)=0.157,P=0.692)。结论低分子肝素联合地屈孕酮治疗可改善先兆流产合并宫腔积血患者的激素水平、凝血–纤溶指标、炎症因子水平,提高患者的妊娠成功率。Objective To analyze the clinical effect of low molecular weight heparin combined with dydrogesterone in the treatment of threatened abortion complicated with intrauterine hematocele.Methods A total of 80 patients with threatened abortion complicated with intrauterine hematocele admitted to Women’s Hospital School of Medicine Zhejiang University from March 2021 to March 2022 were selected as subjects.According to the random number table method,the patients were divided into control group and study group,with 40 cases in each group.Patients in control group were treated with dydrogesterone,and patients in study group were treated with low molecular weight heparin based on control group.Hormone levels,coagulation-fibrinolytic indexes,inflammatory factors and ultrasound parameters were compared before and after treatment between the two groups,and pregnancy success rate and incidence of adverse reactions were recorded.Results After treatment,the levels of progesterone,human chorionic gonadotrophin(HCG),estradiol(E2),peak systolic velocity(PSV),end diastolic velocity(EDV),prothrombin time(PT),activated partial thromboplastin time(APTT),interleukin(IL)-4,and IL-10 were all significantly higher than before treatment,hematoma area,arterial resistance index(RI),fibrinogen(FIB),D-dimer(D-D)and tumor necrosis factor-α(TNF-α)were significantly lower than before treatment(P<0.05).The levels of progesterone,HCG,E2,PSV,EDV,PT,APTT,IL-4 and IL-10 in study group were significantly higher than those in control group,while the hematoma area,arterial RI,FIB,D-D and TNF-αin study group were significantly lower than those in control group(P<0.05).The pregnancy success rate in study group was significantly higher than that in control group(χ^(2)=4.501,P=0.034).There was no statistical significance in the incidence of adverse reactions between the two groups(χ^(2)=0.157,P=0.692).Conclusion Low molecular weight heparin combined with dydrogesterone can improve the levels of hormones,coagulation-fibrinolytic indexes and inflammator

关 键 词：先兆流产 宫腔积血 低分子肝素 地屈孕酮 

分 类 号：R714.21[医药卫生—妇产科学]