低分子肝素钠联合黄体酮对先兆流产的疗效分析
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摘要
目的 观察并分析低分子肝素钠联合黄体酮治疗先兆流产的临床疗效。方法 回顾性选取2017年1月至2018年6月在杭州市余杭区第一人民医院妇产科就诊的先兆流产患者241例作为研究对象,其中将采用低分子肝素钠联合黄体酮进行治疗的125例患者作为观察组,采用常规剂量黄体酮治疗的116例患者作为对照组。收集并比较两组患者的临床疗效以及腰酸、阴道流血、腹痛以及总治疗时间;同时比较两组患者治疗前后超敏C-反应蛋白、纤维蛋白原、D-二聚体、血小板水平的变化以及药物不良反应发生情况。结果 经比较,观察组的总有效率显著高于对照组(92.00%vs. 80.17%,χ~2=7.122,P=0.008),且观察组腰酸、阴道出血、腹痛等症状持续时间以及总治疗时间也都显著低于对照组患者(t值分别为19.369、4.474、 5.145、14.502,均P<0.001)。此外,观察组超敏C-反应蛋白、纤维蛋白原、D-二聚体、血小板等指标的下降程度也显著高于对照组(t值分别为12.621、10.828、4.653、2.099,均P<0.05),且观察组不良反应的发生率显著低于对照组(5.60%vs.16.38%,χ~2=7.264,P=0.007)。结论 相比单纯使用黄体酮,联用低分子肝素钠治疗先兆流产时,可以提高临床治疗效果,降低不良反应发生率,具有较高的有效性及用药安全性。
Objective To observe the clinical efficacy of low molecular weight heparin and progesterone in patients with threatened abortion. Methods 241 patients with threatened abortion admitted in the First People's Hospital of Yuhang between January 2017 and June 2018 were enrolled: 125 patients treated with low molecular weight heparin combined with progesterone was used as the observation group, and 116 patients treated with conventional doses of progesterone were used as the control group. The clinical efficacy, backache, vaginal bleeding, abdominal pain time, total treatment time of the two groups were recorded and compared. And the high-sensitivity C-reactive protein, fibrinogen, D-dimer, platelet level and drug adverse effects were also collected and compared before and after treatment. Results By comparison, the total effective rate in the observation group was significantly higher than control group(92.00% vs. 80.17%, χ~2=7.122, P=0.008), and the duration of lumbar acid, vaginal bleeding, abdominal pain and the total treatment time in the observation group were also significantly lower than those in the control group(t value was 19.369, 4.474, 5.145 and 14.50, respectively, all P<0.001). Meanwhile, the changes of hypersensitive C-reactive protein, fibrinogen, D-dimeric and platelet in the observation group before and after treatment were all significantly higher than those in the control group(t value was 12.621, 10.828, 4.653 and 2.099, respectively, all P<0.05), and the risk of adverse reactions in the observation group was significantly lower than that in the control group(5.60% vs. 16.38%, χ~2=7.264, P=0.007). Conclusion Low molecular weight heparin combined with progesterone has higher efficacy and safety, which can improve the clinical efficacy and reduce the risk of adverse reactions in the treatment of threatened abortion.
Objective To observe the clinical efficacy of low molecular weight heparin and progesterone in patients with threatened abortion. Methods 241 patients with threatened abortion admitted in the First People's Hospital of Yuhang between January 2017 and June 2018 were enrolled: 125 patients treated with low molecular weight heparin combined with progesterone was used as the observation group, and 116 patients treated with conventional doses of progesterone were used as the control group. The clinical efficacy, backache, vaginal bleeding, abdominal pain time, total treatment time of the two groups were recorded and compared. And the high-sensitivity C-reactive protein, fibrinogen, D-dimer, platelet level and drug adverse effects were also collected and compared before and after treatment. Results By comparison, the total effective rate in the observation group was significantly higher than control group(92.00% vs. 80.17%, χ~2=7.122, P=0.008), and the duration of lumbar acid, vaginal bleeding, abdominal pain and the total treatment time in the observation group were also significantly lower than those in the control group(t value was 19.369, 4.474, 5.145 and 14.50, respectively, all P<0.001). Meanwhile, the changes of hypersensitive C-reactive protein, fibrinogen, D-dimeric and platelet in the observation group before and after treatment were all significantly higher than those in the control group(t value was 12.621, 10.828, 4.653 and 2.099, respectively, all P<0.05), and the risk of adverse reactions in the observation group was significantly lower than that in the control group(5.60% vs. 16.38%, χ~2=7.264, P=0.007). Conclusion Low molecular weight heparin combined with progesterone has higher efficacy and safety, which can improve the clinical efficacy and reduce the risk of adverse reactions in the treatment of threatened abortion.
引文
[1]Wang Y H,Liu S Q,Yang S,et al.Determination of ovarian cyclicity and pregnancy using fecal progesterone in forest musk deer (Moschus berezovskii)[J].Animal Reproduction Science,2016,170:1-9.
[2]Calapai G,Imbesi S,Miroddi M,et al.Adverse reaction after administration of progesterone [J].Allergologia et immunopathologia,2014,42(4):377-379.
[3]李巍,韩艳秋.低分子肝素钠联合低剂量黄体酮治疗先兆流产的临床观察[J].临床医药文献电子杂志,2018,5(71):89.
[4]谢幸,孔北华,段涛,等.妇产科学[M].9版.北京:人民卫生出版社,2018.
[5]Lee H J,Park T C,Kim J H,et al.The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion:A Systematic Review and Meta-Analysis[J].Biomed Res Int,2017,2017:3616875.
[6]Kryvopustor O S,Dosenko V E.Progesterone Receptor Gene Polumorphisms as Genetic Risk of Threatened Abortion[J].Fiziolohichnyi Zhurnal,2016,62(6):60-64.
[7]李慧,吴小妹,周玉华.低分子肝素钠联合地屈孕酮治疗先兆流产的临床观察[J].中国药房,2017,28(18):2499-2502.
[8]Shaaban O M,Abbas A M,Zahran K M,et al.Low-Molecular-Weight Heparin for the Treatment of Unexplained Recurrent Miscarriage With Negative Antiphospholipid Antibodies:A Randomized Controlled Trial[J].Clinical and applied thrombosis/hemostasis :official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis,2017,23(6):567-572.
[9]郭跃丽,万菁,孔万仲等.Hcy联合凝血功能检测在早孕先兆流产中的应用[J].中国妇幼健康研究,2015,26(2):289-291.
[10]宋祥芳.对比黄体酮与地屈孕酮用于早期先兆流产保胎治疗的临床效果观察[J].中国妇幼健康研究,2016,27(1):234.
[2]Calapai G,Imbesi S,Miroddi M,et al.Adverse reaction after administration of progesterone [J].Allergologia et immunopathologia,2014,42(4):377-379.
[3]李巍,韩艳秋.低分子肝素钠联合低剂量黄体酮治疗先兆流产的临床观察[J].临床医药文献电子杂志,2018,5(71):89.
[4]谢幸,孔北华,段涛,等.妇产科学[M].9版.北京:人民卫生出版社,2018.
[5]Lee H J,Park T C,Kim J H,et al.The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion:A Systematic Review and Meta-Analysis[J].Biomed Res Int,2017,2017:3616875.
[6]Kryvopustor O S,Dosenko V E.Progesterone Receptor Gene Polumorphisms as Genetic Risk of Threatened Abortion[J].Fiziolohichnyi Zhurnal,2016,62(6):60-64.
[7]李慧,吴小妹,周玉华.低分子肝素钠联合地屈孕酮治疗先兆流产的临床观察[J].中国药房,2017,28(18):2499-2502.
[8]Shaaban O M,Abbas A M,Zahran K M,et al.Low-Molecular-Weight Heparin for the Treatment of Unexplained Recurrent Miscarriage With Negative Antiphospholipid Antibodies:A Randomized Controlled Trial[J].Clinical and applied thrombosis/hemostasis :official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis,2017,23(6):567-572.
[9]郭跃丽,万菁,孔万仲等.Hcy联合凝血功能检测在早孕先兆流产中的应用[J].中国妇幼健康研究,2015,26(2):289-291.
[10]宋祥芳.对比黄体酮与地屈孕酮用于早期先兆流产保胎治疗的临床效果观察[J].中国妇幼健康研究,2016,27(1):234.