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目的:探讨思美泰与熊去氧胆酸联合应用治疗妊娠期肝内胆汁郁积症(ICP)患者的临床疗效。方法:将88例ICP患者随机分为对照组和治疗组,每组44例。治疗组采用思美泰1 000 mg加入5%葡萄糖注射液250 mL中静脉滴注,1次/d;熊去氧胆酸300 mg,口服,3次/d。对照组采用10%葡萄糖500ml加维生素C 3.0 g,维生素B6200 mg,三磷酸腺苷(ATP)40mg,辅酶A100U静脉滴注,1次/d,以7天为1个疗程,加地塞米松10 mg肌注1次/d连续3天,治疗3周或到分娩止。观察治疗前后两组患者皮肤瘙痒评分情况变化、肝功能指标变化及妊娠结局及围生儿情况比较。结果:治疗后两组患者皮肤瘙痒评分均下降,治疗组与对照组比较,差异有统计学意义(P<0.05);治疗后两组患者的TBA、TB、ALT、AST均较治疗前有所下降,且两组患者肝功能指标比较,差异均具有统计学意义(P<0.05);对照组与治疗组孕妇妊娠结局及围生儿情况比较,治疗组早产率、剖宫产率、胎儿窘迫率、羊水污染率均显著低于对照组(P<0.01),差异均具有统计学意义。结论:思美泰联合熊去氧胆酸治疗ICP更能有效缓解皮肤瘙痒症状,降低血胆汁酸、转氨酶及总胆红素浓度,从而降低早产率、剖宫产率、胎儿窘迫、羊水污染程度发生率。思美泰与熊去氧胆酸联合用药是治疗ICP的安全有效的方法。
Objective: To investigate the clinical effect of Smectite combined with ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy (ICP). Methods: 88 patients with ICP were randomly divided into control group and treatment group, 44 cases in each group. The treatment group with Smectite 1000 mg 5% glucose injection 250 mL intravenous infusion, 1 / d; ursodeoxycholic acid 300 mg, orally, 3 times / d. The control group was treated with 10% glucose 500ml plus vitamin C 3.0 g, vitamin B6200 mg, adenosine triphosphate (ATP) 40mg, coenzyme A100U intravenously once a day for 7 days and a dexamethasone 10 mg intramuscular injection Times / d for 3 consecutive days, treatment for 3 weeks or until the end of childbirth. Changes of pruritus scores, changes of liver function indexes, pregnancy outcomes and perinatal conditions in both groups before and after treatment were observed. Results: The pruritus scores of both groups decreased after treatment, the difference between the treatment group and the control group was statistically significant (P <0.05); after treatment, the TBA, TB, ALT and AST in both groups were significantly higher than those before treatment (P <0.05). Compared with the pregnant women in the control group and the pregnant women in the treatment group, the prevalence of preterm birth, cesarean section rate and fetal distress in the treatment group were significantly lower than those in the control group Rate of amniotic fluid contamination were significantly lower than the control group (P <0.01), the differences were statistically significant. Conclusion: The combination of Smectite and ursodeoxycholic acid can effectively relieve pruritus and reduce the levels of bile acid, aminotransferase and total bilirubin, so as to reduce the premature delivery rate, cesarean section rate, fetal distress, amniotic fluid contamination Occurrence rate. Simei Thai and ursodeoxycholic combination therapy is a safe and effective method of treatment of ICP.