摘要
[目的]探讨低分子肝素钙（1ow molecular weight heparin calcium,LM-WHC）对妊娠期肝内胆汁淤积症患者胎儿脐血流及围生儿的影响.[方法]本院收治的116例妊娠期肝内胆汁淤积症患者,随机分为对照组与观察组,对照组采用口服熊去氧胆酸[15 mg/（kg·d）],静滴还原性谷胱甘肽（1.8 g/d）.观察组在对照组的基础上,给予低分子肝素钙治疗.于治疗前及终止妊娠前用彩色多普勒超声监测每组胎儿脐血流收缩期最大血流速度/舒张期末血流速度的比值（S/D）、阻力指数（RI）、搏动指数（PI）,新生儿出生时1分钟Apgar评分、测量新生儿体重及记录胎龄.[结果]①随着孕周的增加,脐血流S/D、RI有降低的趋势,治疗后观察组脐血流S/D 比值、RI、PI、显著低于对照组（P〈0.05）;②两组新生儿1分钟Apgar评分比较无显著差异（P〉0.05）;③观察组新生儿体重高于对照组,胎龄显著延长（P〈0.05）.[结论]低分子肝素钙可显著改善脐血流,降低S/D 比值、PI、RI,改善宫内环境,促进胎儿生长发育,延长孕周,使新生儿体重增加,且对母、儿无不利影响;RI可作为妊娠期肝内胆汁淤积症患者治疗效果观察指标.
[Objective] To explore the effect of low molecular weight heparin calcium（LM-WHC） on umbilical blood flow and prenatal morality in patients with intrahepatic cholestasis of pregnancy. [Methods] Totally 116 patients with intrahepatic cholestasis of pregnancy in our hospital were randomly divided into control group and observation group. The control group was given oral ursodeoxycholic acid（15mg/Kg, d） and injected with reduced glutathione sodium（1.8g/d）. The observation group was treated with additional LM-WHC based on the therapy of control group. Systole peak velocity/end-diastole blood flow velocity（S/D） of fetal umbilical blood flow, resistance index（RI） and pulsatility index（PI） were monitored by color Doppler ultrasound before treatment and termination of pregnancy. Neonatal Apgar score at 1st minute before birth and body weight were measured and the gestational age was recorded. [Results]As the gestational age increased, S/D ratio of umbilical cord blood and RI decreased. After treatment, the S/D ratio of umbilical cord blood, RI and PI in observation group were obviously lower than those in control group（ P〈0.05）. There was no significant difference in neonatal Apgar score at 1st minute before birth between two groups（ P〉0.05）. Body weight of neonates in observation group was higher than that in control group（ P〈0.05）, and the gestational age was significantly prolonged（ P〈0.05）. [Conclusion] LM-WHC can markedly improve umbilical blood flow and intrauterine environment, decrease S/D ratio, PI and RI, promote fetal growth and development, prolong the gestation age and increase neonate body weight. LM-WHC is also safe for both the mothers and their fetuses. The resistance indexes of umbilical blood flow can be used as the observation indicators of therapeutic effect of patients with intrahepatic cholestasis of pregnancy.
出处
《医学临床研究》
CAS
2011年第9期1741-1743,共3页
Journal of Clinical Research
