妊娠高血壓綜合徵 重度 硫酸鎂 低分子肝素 治療
Objective To investigate the clinical value of severe pregnancy -induced hypertension syndrome treatment by low molecular weight heparin with magnesium ods 60 patients with severe pregnancy-induced hypertension syndrome were randomly divided into two groups. 30 patients were in control group and spasmolysis treated with magnesium sulfate,30 patients were in observation group and treated with low molecular weight heparin based on control group. The index of whole blood viscosity, coagulation function,hematocrit,plasma D-dimer, platelet aggregation, postpartum hemorrhage in the two groups before and after treatment were lts The index of whole blood viscosity(11.5±0.3/mPa•s)and hematocrit (0.2±0.1%)in observation group After treatment were significantly lower than the control group(17.6±0.5/mPa•s,0.4±0.1%)(t=2.415,2.348,all P<0.05);The index of D-dimer(1.97±0.63mg/L)and platelet aggregation(51.4±14.0%)in observation group after treatment were significantly lower than the control group(2.25±0.72mg/L,62.3±15.2%)(t=2.311,2.344,all P<0.05)lusion The curative effect of low molecular weight heparin with magnesium sulfate is better than traditional method and can not increase adverse reaction of drugs in Patients with severe pregnancy-induced hypertension syndrome
Pregnancy induced hypertension Severe Magnesium sulfate Low molecular weight heparin Treatment
妊娠期高血壓疾病是妊娠期特有的以高血壓、水腫、蛋白尿為主要特徵的疾病,是孕婦和圍生兒死亡的主要原因,其主要病理變化是全身小動脈痙攣, 傳統治療重度妊高徵以硫酸鎂解痙為主,輔以降壓、鎮靜、合理擴容及利尿,適時終止妊娠。低分子肝素治療重度妊高徵的理論基礎是通過抗凝血活酶(AT)而增強其對凝血因子Xa和凝血酶的抑制,因而發揮其抗凝作用。本文用低分子肝素聯合硫酸鎂治療重度妊娠高血壓綜合徵,取得良好效果,現報道如下。
1 資料與方法
1.1一般資料 選取2008年1月-2010年12月我院診治的重度妊娠高血壓綜合徵患者60例,按住了方法不同，分為低分子肝素聯合硫酸鎂治療組(觀察組,n=30)，年齡21～35(2735±4.5)歲，孕周31～37(35.2±3.0)周,經產婦11例；硫酸鎂治療組(對照組,n=30),年齡22～34(26.9±3.5)歲,孕周32～38(36.1±2.6)周,經產婦12例。診斷依據《婦產》(第7版)制訂的標準，2組患者均為單胎,無其他併發症,未使用對凝血功能有影響的其他藥物,年齡、孕周、孕次比較均無顯著性差異(P>0.05),具有可比性。
1.2治療方法 將60例重度妊高徵患者隨機分為：硫酸鎂治療組(對照組,n=30)，首次給負荷量5 g硫酸鎂迅速滴完,隨即10%葡萄糖500 ml+25%硫酸鎂70ml，以1.5～2.0g/h滴完；低分子肝素聯合硫酸鎂治療組(觀察組,n=30)，在對照組治療基礎上，每日皮下注射低分子肝素5000 IU。2組同時口服拉貝洛爾100mg每日2次。並監測膝腱反射、呼吸和尿量。分別監測治療前和治療後第5天的D-二聚體、血小板計數、凝血酶原時間結果,觀察產後出血量。
1.3觀察指標 觀察患者治療前後血壓、尿量、尿蛋白、全血比黏度、紅血球壓積、凝血系列包括血漿凝血酶原時間(PT)、活化部分凝血活酶時間(APTT)、血漿D-二聚體、血小板最大聚集率、出血量。
1.4統計學處理 應用SPSS13.0統計軟體進行處理，資料以x±s表示,組間比較採用t檢驗,P<0.05為有顯著性差異。
2 結果
2.1 兩組治療前後全血比黏度、紅血球壓積、凝血功能指標比較 觀察組治療後全血比黏度(11.5±0.3/mPa·s)及紅血球壓積(0.2±0.1%)明顯低於對照組(17.6±0.5/mPa·s, 0.4±0.1%) (t=2.415,2.348,P均<0.05), 2組治療前後凝血功能指標無明顯變化，見表1。
表1 2組治療前後全血比黏度、紅血球壓積、凝血功能指標比較(x±s)
2.2 兩組治療前後血漿D-二聚體、血小板最大聚集率水平比較 觀察組治療後D-二聚體(1.97±0.63mg/L)及血小板最大聚集率(51.4±14.0%)明顯低於對照組(2.25±0.72mg/L, 62.3±15.2%) (t=2.311,2.344,P均<0.05)，見表2。
表2 2組重度妊高徵患者水平比較(x±s)