小剂量低分子肝素联合免疫球蛋白治疗难治性先兆流产合并绒毛膜下血肿效果评价

摘要

目的 探讨小剂量低分子肝素联合免疫球蛋白治疗难治性先兆流产合并绒毛膜下血肿(SCH)的临床效果.方法 选取2016年1月至2017年3月就诊的116例难治性先兆流产合并SCH的患者,将期随机分为对照组和研究组,每组58例.对照组患者进行常规的黄体支持、解痉、止血及预防感染、中药固肾安胎等对症安胎治疗;研究组在用常规治疗方法的基础上加用小剂量低分子肝素(一天一次,一次5 000 IU的达肝素钠)及静脉使用免疫球蛋白(一次25 g,一周一次).观察对比两组患者继续妊娠率、活产率、先兆流产征象消失时间、SCH消失时间、胎儿生长受限、羊水过少、胎膜早破及胎盘粘连等妊娠并发症的发生率及结局,评估两种治疗方案的优缺点.结果 研究组继续妊娠患者50例,8例流产,继续妊娠率86.7%;对照组继续妊娠35例,23例发生流产,继续妊娠率61.5%,研究组继续妊娠率高于对照组,差异具有统计学意义(p<0.05);研究组活产48例,活产率83.7%;对照组活产33例,活产率57.5%,研究组活产率高于对照组,差异具有统计学意义(p<0.05);研究组胎儿生长受限、羊水过少、胎膜早破及胎盘粘连等妊娠并发症的发生率为6.9%,对照组上述妊娠并发症发生率20.7%,研究组妊娠并发症的发生率低于对照组,差异具有统计学意义(p<0.05);研究组阴道出血及下腹痛等先兆流产征象消失时间和SCH消失时间均低于对照组(1.0±0.56周 vs.2.0±0.81周;1.5±0.84周 vs.2.0±1.14周),差异具有统计学意义(p<0.05).结论 对难治性先兆流产合并SCH的患者,采用在常规保胎方法的基础上使用小剂量低分子肝素及免疫球蛋白安胎,促进SCH的快速吸收及先兆流产症状的改善,能明显提高继续妊娠率及活产率,减少流产率及复发性流产发生率,降低妊娠相关并发症的发生,改善妊娠结局,在临床上值得推广应用.%Objective To discuss the effect of small low molecular weight heparin with immunoglobulin to cure refractory threatened abortion with Subchorionic hematoma (SCH) clinical effect.Methods A total of 116 patients with refractory threatened abortion combined with SCH from January 2016 to March 2017 were randomly divided into control group and study group, 58 cases in each group.The control group patients were treated with normal luteal support, spasmolysis, stop bleeding and prevent infection, traditional Chinese medicine (TCM) solid renal fetus fetus therapy, etc;the study group were treated on the basis of conventional treatment combined with small low molecular weight heparin (once a day, a 5000 iu of heparin sodium) and intravenous immunoglobulin (25 g at a time, once a week).Continuous pregnancy rate, live birth rate, threatened abortion signs disappear time, SCH disappear time, fetal growth restriction and oligohydramnios, premature rupture of membranes and placenta adhesion, the incidence and outcome of pregnancy complications were compared.The advantages and disadvantages of different treatment options were compared.Results There were 50 patients of continuous pregnancy, 8 cases of abortion, pregnancy rate 86.7% in the study group;35 cases of continuous pregnancy, 23 cases of abortion, pregnancy rate was 61.5% in the control group;the difference was statistically significant (p<0.05).The survival rate was 83.7% in the study group.The live birth rate was 57.5% in the control group.The survival rate of the study group was higher than that of the control group (p<0.05).The fetal growth restriction and oligohydramnios, premature rupture of membranes, and the incidence of placenta adhesion and other pregnancy complications in the study group was 6.9%, pregnancy complication rates above in the control group was 20.7%, the difference was statistically significant (p<0.05).In the study group, the disappearance time and the disappearance time of threatened abortion were lower in the control group than those in the control group, the difference was statistically significant (p<0.05).Conclusion In patients with refractory threatened abortion with SCH, adopting the traditional spuc method on the basis of using small low molecular weight heparin with immunoglobulin fetus, can promote the rapid absorption of SCH and threatened abortion symptoms improve, increase obviously the pregnancy rate and live-birth rate, reduce the abortion rate and the incidence of recurrent miscarriage, can shorten the hospitalization time of patients with SCH and reduce the incidence of complications related to pregnancy, improve the pregnancy outcome, is worthy of popularization and application in clinic.