| 摘要: |
| ［摘要］ 目的 探讨抗凝药物对妊娠期高血压疾病(早发型子痫前期、慢性高血压并发子痫前期)母胎结局的影响。方法 将2014-01～2016-12在广西医科大学第一附属医院产科住院引产或分娩的诊断为早发型子痫前期或慢性高血压并发子痫前期的60例孕妇作为研究对象，按照随机数字表法分为对照组和观察组各30例，对照组孕期给予常规治疗，观察组孕期(孕12～14周开始）给予抗凝药物治疗（阿司匹林片，口服，50～75 mg/d，14～28 d，和那曲肝素钙注射液4 100 U/d,皮下注射，7～10 d）。比较两组母胎结局。结果 两组孕妇治疗前及治疗后1个月的凝血功能比较，差异均无统计学意义（P>0.05）。观察组在改善脐血流异常、胎儿生长受限，减少胎儿窘迫、新生儿窒息发生优于对照组（P<0.05）；不增加孕妇妊娠期高血压并发症如HELLP综合征、产后出血、胎盘早剥、剖宫产率、早产率、胎儿畸形、围产儿死亡等风险（P>0.05）；观察组有子痫前期病史的6例孕妇此次妊娠与上次妊娠的发现血压高孕周及终止妊娠孕周对比，发现血压高孕周及终止妊娠孕周明显延长，差异有统计学意义（P<0.05）。结论 （1）孕早期(孕12周)开始使用抗凝治疗至28周，对妊娠期高血压疾病（尤其是早发型子痫前期和慢性高血压并发子痫前期）可延长妊娠孕周，改善母胎结局。（2）有子痫前期病史的孕妇在孕早期（孕12周）口服阿斯匹林片50～75 mg/d，可延迟子痫前期终止妊娠孕周。（3）孕期口服阿斯匹林片在安全剂量（50～100 mg）下使用不增加产后出血、胎盘早剥等风险，无致畸作用，安全有效。 |
| 关键词: 抗凝治疗 妊娠期高血压疾病 子痫前期 阿司匹林 那曲肝素钙 |
| DOI：10.3969/j.issn.1674-3806.2018.07.03 |
| 分类号:R 714.24+6 |
| 基金项目:广西自然科学基金项目（编号：2015GXNSFAA139191） |
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| Effects of anticoagulants on maternal and fetal outcomes of hypertensive disorders in pregnancy |
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WU Fang, WANG Su-mei, GE Li-ping
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Department of Obstetrics, Red Cross Hospital of Nanning City, Guangxi 530012, China
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| Abstract: |
| ［Abstract］ Objective To study the effects of anticoagulants on maternal and fetal outcomes of hypertensive disorders in pregnancy (early onset preeclampsia and chronic hypertension complicated with preeclampsia). Methods A total of 60 inpatients from the Department of Obstetrics of the First Hospital Affiliated to Guangxi Medical University were randomly divided into two groups during January 2014 and December 2016, with 30 cases in each group. The control group received conventional treatments and the observation group was given anticoagulant treatment（oral aspirin tablet, 50～75 mg/d for 14～28 d plus nadroparin calcium hypodermic injection, 4 100 U/d for 7～10 d） starting at 12 to 14 weeks of pregnancy. The maternal and fetal outcomes were compared between the two groups. Results There was no significant difference in blood coagulation function between the two groups before and one month after treatment（P>0.05）. The observation group was superior to the control group in the improvements of abnormal umbilical blood flow, fetal growth restriction, reduction of fetal distress and neonatal asphyxia（P<0.05）, but the complications of hypertension during pregnancy were not increased in the observation group including HELLP syndrome, postpartum hemorrhage, placental abruption, cesarean section rate, premature birth rate and perinatal mortality rate（P>0.05）. 6 cases with a history of preeclampsia in the observation group had longer gestational weeks of hypertensive disorders in pregnancy and termination of pregnancy than those they had during the previous pregnancy. Conclusion (1)Anticoagulants are feasible for preeclampsia and chronic hypertension complicated with preeclampsia, and they can prolong gestational weeks and improve the pregnancy outcomes. (2)Oral aspirin tablet(50～75 mg/d for 14～28 d) can prolong the gestational weeks for the early pregnancy women(12 weeks of pregnancy) with a history of preeclampsia. (3)Oral aspirin tablet in a safe dose（50～100 mg） does not increase the risk of postpartum hemorrhage, placental abruption and teratogenesis. |
| Key words: Anticoagulant treatment Hypertensive disorders in pregnancy Preeclampsia Aspirin Nadroparin calcium |
