低分子肝素治疗妊娠中晚期脐血流异常疗效观察

Observation of Curative Effect of Low-Molecular-Weight Heparin on Abnormal Umbilical Blood Flow at Second and Third Trimester of Pregnancy

摘要: 目的：评价低分子肝素(low molecular weight heparin, LMWH)在妊娠中晚期妊娠脐动脉血流异常治疗中的作用，寻找改善脐动脉血流异常的有效治疗方法。方法：采用随机数字分组法回顾性分析在青岛大学附属烟台毓璜顶医院2016年09月至2019年04月收治的106例妊娠中晚期脐动脉血流异常的患者分为两组，每组各53例。治疗组患者给予皮下注射低分子肝素钠5000IU q12h，吸氧3升/分bid治疗，对照组仅给予吸氧治疗。对两组患者妊娠期的脐动脉血流变化、分娩孕周、产时羊水情况及分娩后新生儿妊娠结局进行分析。结果：治疗组治疗前脐动脉收缩期最大血流速度(S)与舒张末期血流速度(D)的比值，即S/D比值为4.43 ± 1.01，治疗后3.21 ± 0.83，差异具有显著性(P < 0.01)。对照组治疗前S/D比值3.78 ± 0.62，治疗后3.14 ± 0.52，差异具有显著性(P < 0.01)。比较两组治疗前后S/D差值变化，治疗组S/D差值1.14 ± 0.98，对照组0.04 ± 0.66，相较对照组差异具有显著性(P < 0.05)。治疗组脐动脉血流S/D比值下降率为100%，对照组为80.95%，两组比较差异有统计学意义(χ² = 6.78, P < 0.05)；治疗组分娩孕周37.40 ± 2.32周，对照组38.21 ± 2.24周，两组比较差异具有显著性(P < 0.05)；治疗组足月儿生后1分钟Apgar评分9.96 ± 0.19，对照组为9.89 ± 0.60，差异具有显著性(P < 0.05)。治疗组产时羊水粪染的发生率为14.28%，对照组发生率22.22%，差异有统计学意义(χ² = 25.404, P < 0.05)。当S/D ≥ 3.5时，围产儿预后不良发生率显著增加，发生新生儿肺炎、新生儿窒息的概率较S/D < 3的新生儿发病率高，相比具有统计学意义(P < 0.05)，需转入新生儿科治疗。当S/D ≥ 4时，新生儿小于胎龄儿的概率也明显增加，具有统计学意义(P < 0.05)。结论：低分子肝素可改善新生儿结局，在妊娠中晚期脐动脉血流异常治疗中效果确切。

Abstract: Objective: To evaluate the role of low molecular weight heparin (LMWH) in the treatment of abnormal cord artery blood flow in late pregnancy, and to find effective treatment methods to improve cord arterial blood flow abnormalities. Methods: The clinical data of 106 consecutive patients with abnormal umbilical artery blood flow in the middle and late stages of pregnancy in the Affiliated Yantai Yuhuangding Hospital of Qingdao University from September 2016 to April 2019 were collected and analyzed retrospectively. The patients who had received subcutaneous injection of LMWH sodium 5000IU q12h and oxygen therapy at 3 L/min for 30 min, t.i.d. were defined as the therapy group (N = 53) and those received oxygen treatment only fell into the control group (N = 53). The changes in UMA indexes during pregnancy [including the ratio of the maximum systolic blood flow velocity to the end-diastolic blood flow velocity (S/D), resistance index (RI), and pulsation index (PI)], the gestational age, condition of amniotic fluid during delivery, and the outcome of newborns were analyzed. Results: In the therapy group, the S/D value reduced significantly from 4.43 ± 1.01 before treatment to 3.21 ± 0.83 after treatment (P < 0.01). In the control group, the S/D value reduced significantly from 3.78 ± 0.62 before treatment to 3.14 ± 0.52 after treatment (P < 0.01). The reduction in S/D value after treatment in the therapy group was 1.14 ± 0.98, which was significantly bigger than the 0.04 ± 0.66 reduction in the control group (P < 0.05). The rate of UMA S/D reduction after treatment was 100% in the therapy group, with was significantly higher than the 80.95% in the control group (χ² = 4.39, P < 0.05). The gestational age of therapy group (38.21 ± 2.24 weeks) was significantly longer than the control group (37.40 ± 2.32 weeks) (P < 0.05). The 1-minute Apgar score in the therapy group was 9.96 ± 0.19, and that in the control group was 9.89 ± 0.60, the difference was significant (P < 0.05). The incidence of meconium-stained amniotic fluid (MSAF) in the therapy group (14.28%) was significantly lower than that in the control group (22.22%) (χ² = 25.404, P < 0.05). When S/D ≥ 3.5, the incidence of poor prognosis in perinatal infants increased significantly, with significantly increased probability of neonatal pneumonia and neonatal asphyxia, and requirement of transfer to the pediatrics department for further treatment (P < 0.05). When S/D ≥ 4, the incidence of infants smaller than gestational age also increased significantly (P < 0.05). Conclusion: LMWH could improve neonatal outcomes and was effective in the treatment of abnormal umbilical artery blood flow in the second and third trimester of pregnancy.