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目的观察不同剂量低分子肝素(LMWH)辅助治疗重度子痫前期的有效性及安全性。方法选取2009年11月至2011年3月在北京友谊医院住院的重度子痫前期患者71例,随机分为常规治疗组(A组20例)、常规疗法+LMWH 25IU/kg·d组(B组17例)、常规疗法+LMWH 50IU/kg·d组(C组16例)、常规疗法+LMWH 75IU/kg·d组(D组18例),连续治疗7d。观察不同剂量LMWH辅助治疗重度子痫前期在改善临床症状、实验室指标(凝血功能、肝肾功能、血常规、尿蛋白)和围产结局的作用。结果①AT-Ⅲ在A组治疗后有上升,差异无统计学意义(P>0.05);应用LMWH的BCD组治疗后均有下降,各组间比较差异均有统计学意义(P<0.05);但仅B组治疗后显著低于治疗前,差异有统计学意义(P=0.020);D组治疗后24h尿蛋白定量显著低于治疗前(P=0.028);②不同剂量LMWH组治疗后收缩压均显著低于治疗前(分别为P=0.010、P=0.002、P=0.002、P=0.014)。A组和B组治疗后舒张压显著低于治疗前(P=0.007、P=0.003)。其余各项指标治疗前后比较差异无统计学意义(P>0.05)。母婴围产结局各组比较差异无统计学意义(P>0.05)。结论在常规治疗子痫前期的同时加用不同剂量的LMWH对肝肾功能、血常规指标、凝血指标、母婴围产结局未产生明显影响,但大剂量LMWH(75IU/kgd)在改善24h尿蛋白定量上有一定作用,并是安全的。血压改善的主要作用仍然是常规治疗方法。
Objective To observe the efficacy and safety of different doses of low molecular weight heparin (LMWH) in adjuvant treatment of severe preeclampsia. Methods Seventy-one patients with severe preeclampsia hospitalized in Beijing Friendship Hospital from November 2009 to March 2011 were randomly divided into routine treatment group (20 cases in group A), conventional therapy + LMWH 25 IU / kg · d group (B (N = 17, n = 17). The patients were treated with LMWH 50 IU / kg · d (16 cases in group C) and conventional therapy with 75 IU / kg · d in LMWH group (18 cases in group D) To observe the effect of different doses of LMWH adjuvant therapy on improving the clinical symptoms, laboratory indexes (coagulation, liver and kidney function, blood, urinary protein) and perinatal outcome in patients with severe preeclampsia. Results ① The level of AT-Ⅲ increased after treatment in group A, but the difference was not statistically significant (P> 0.05). The level of AT-Ⅲ decreased after treatment in group BCD with LMWH, and the difference was statistically significant (P <0.05). But only B group after treatment was significantly lower than before treatment, the difference was statistically significant (P = 0.020); D group 24h urine protein was significantly lower than before treatment (P = 0.028); ② different doses of LMWH group after treatment shrink Pressure was significantly lower than before treatment (P = 0.010, P = 0.002, P = 0.002, P = 0.014, respectively). Diastolic blood pressure after treatment in group A and group B was significantly lower than before treatment (P = 0.007, P = 0.003). The rest of the indicators before and after treatment was no significant difference (P> 0.05). Maternal and infant perinatal outcomes in each group was no significant difference (P> 0.05). Conclusion In the routine treatment of preeclampsia with different doses of LMWH on liver and kidney function, blood parameters, coagulation parameters, maternal and infant perinatal outcomes did not produce significant effects, but high-dose LMWH (75IU / kgd) improved 24h urinary protein quantitative has a certain effect, and is safe. The main effect of blood pressure improvement is still routine treatment.