标题：硫酸镁联合大剂量低分子肝素方案治疗重度子痫前期合并胎儿生长受限的疗效及安全性

      作者：买苗，姬超，张莉    陕西省第二人民医院妇产科，陕西 西安 710005

      卷次： 2021年32卷24期

      【摘要】 目的 分析硫酸镁联合大剂量低分子肝素方案治疗重度子痫前期合并胎儿生长受限(FGR)的疗效及安全性。方法 选取2014年6月至2020年6月陕西省第二人民医院妇产科收治的120例重度子痫前期合并FGR患者为研究对象，按照随机数表法分为对照组和观察组各60例，对照组患者给予硫酸镁治疗，观察组患者给予硫酸镁联合大剂量低分子肝素方案治疗，两组均持续治疗1周，比较两组患者的临床疗效和治疗前后的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、胎儿生长情况、脐血流指标[子宫动脉搏动指数(PI)、阻力指数(RI)、收缩期与舒张期血流比值(S/D)]及妊娠结局。结果 观察组患者的治疗总有效率为91.67%，明显高于对照组的75.00%，差异具有统计学意义(P<0.05)；治疗后，观察组患者的SBP、DBP、MAP水平和脐动脉PI、RI明显低于对照组，差异均具有统计学意义(P<0.05)；治疗后，观察组患者的胎儿股骨长、双顶径、腹围和头围明显大于对照组，差异均具有统计学意义(P<0.05)；观察组患者的早产率、剖宫产率明显低于对照组，胎儿出生体质量明显高于对照组，差异均具有统计学意义(P<0.05)。结论 硫酸镁联合大剂量低分子肝素方案可降低重度子痫前期合并FGR患者的血压，改善脐血流动力学，有利于促进胎儿生长发育，临床应用治疗效果显著。
      【关键词】 重度子痫前期；胎儿生长受限；硫酸镁；低分子肝素方案；疗效；安全性
      【中图分类号】 R714.24+5 【文献标识码】 A 【文章编号】 1003—6350（2021）24—3209—04

Curative effect and safety of magnesium sulfate combined with high-dose low molecular weight heparin in thetreatment of severe preeclampsia complicated with fetal growth restriction.
MAI Miao, JI Chao, ZHANG Li.Department of Obstetrics and Gynecology, the Second People's Hospital of Shaanxi Province, Xi'an 710005, Shaanxi,CHINA
【Abstract】 Objective To analyze the curative effect and safety of magnesium sulfate combined with high-doselow molecular weight heparin (LMWH) in the treatment of severe preeclampsia complicated with fetal growth restriction(FGR). Methods A total of 120 patients with severe preeclampsia and FGR were selected as the research subjects, whowere admitted to the Department of Obstetrics and Gynecology at the Second People's Hospital of Shaanxi Province be-tween June 2014 and June 2020. They were divided into the control group and the observation group by random numbertable method, with 60 patients in each group. Patients in the control group were treated with magnesium sulfate, whilepatients in the observation group were treated with magnesium sulfate combined with high-dose LMWH. Both groupswere given continuous treatment for 1 week. The clinical effects were compared between the two groups of patients, aswell as the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), fetal growth,umbilical blood flow indexes [uterine artery pulsatility index (PI), resistance index (RI), ratio of systolic to diastolicblood flow (S/D)] and pregnancy outcomes before and after treatment. Results The total response rate in the observa-tion group was 91.67%, which was significantly higher than the 75.00% in the control group, and the difference was sta-tistically significant (P<0.05). After treatment, the levels of SBP, DBP, MAP, umbilical artery PI, and RI of the observa-tion group were significantly lower than those of the control group (P<0.05). After treatment, the fetal femur length, bipa-rietal diameter, abdominal circumference, and head circumference in the observation group were significantly larger thanthose in the control group (P<0.05). The rates of premature delivery and cesarean section in the observation group weresignificantly lower than those in the control group, and fetal birth weight was significantly higher than that in the controlgroup (P<0.05). Conclusion Magnesium sulfate combined with high-dose LMWH can reduce blood pressure, improveumbilical artery hemodynamics in patients with severe preeclampsia and FGR, which is conducive to promoting fetalgrowth and development. The clinical effect is significant.
      【Key words】 Severe preeclampsia; Fetal growth restriction; Magnesium sulfate; Low molecular weight heparin;Curative effect; Safety