摘要
目的探讨药物干预对妊娠期高血压疾病(HDP)结局的影响及疗效。方法选取2020年1月~2022年6月在医院产前门诊或产科住院部确诊为HDP孕妇100例,按照随机数字表法分为对照组和观察组各50例,所有研究对象均接受生活干预和健康宣教。对照组孕期给予常规治疗(降压、解痉、镇静、适时终止妊娠等),观察组孕期给予常规治疗外,分为A、B、C三个亚组:A组联合常规钙剂加小剂量阿司匹林治疗,B组联合叶酸加维生素B_(12)治疗,C组联合那屈肝素钙治疗。用药后观察指标包括凝血功能监测[血浆凝血酶原时间(Prothrombin time,PT)、活化部分凝血酶时间(Activated partial thrombin time,APTT)、D-二聚体(D-dimer,DD)],进行动态血压监测[平均动脉压(Mean arterial pressure,MAP)]与24 h尿蛋白定量。采用三维彩超对患者脐动脉收缩期最大血流速度与舒张末期血流速度的比值(Systolic blood pressure/Diastolic blood pressure,S/D)与阻力指数(Resistance index,RI)进行测定。统计每例孕妇的妊娠结局。结果治疗前各组凝血功能差异无统计学意义(P>0.05),治疗后A、B、C三组PT、APTT高于对照组,DD低于对照组,差异有统计学意义(P<0.05);组内比较:C组PT、APTT高于A、B组,DD低于A、B组,差异有统计学意义(P<0.05),A组与B组PT、APTT、DD差异无统计学意义(P>0.05)。治疗前各组MAP、24 h尿蛋白定量差异无统计学意义(P>0.05),治疗后A、B、C三组MAP、24 h尿蛋白定量低于对照组,差异有统计学意义(P<0.05);组内比较:C组MAP、24 h尿蛋白定量低于A、B组,差异有统计学意义(P<0.05),A组与B组MAP、24 h尿蛋白定量差异无统计学意义(P>0.05)。治疗前各组S/D、RI差异无统计学意义(P>0.05),治疗后A、B、C三组S/D、RI低于对照组,差异有统计学意义(P<0.05);组内比较:C组S/D、RI低于A、B组,差异有统计学意义(P<0.05),A组与B组S/D、RI差异无统计学意义(P>0.05)。观察组剖宫产、新生儿窒息发生率低于对照组,新生儿出生体重增加、延长期待治疗时间发生率高于对照组,差异有统计学意义(P<0.05)。结论给予HDP患者药物干预能够有效控制血压水平,改善其凝血功能,稳定脐动脉血流与改善妊娠结局,且短期治疗使用肝素较其他药物效果更显著及更安全。
Objective To investigate the effect and efficacy of drug intervention on the outcome of hypertensive disorders of pregnancy(HDP).Methods From January 2020 to June 2022,100 pregnant women who were diagnosed with HDP in the antenatal clinic or obstetric inpatient department of the hospital were selected and divided into the control group and the observation group accorded to the random number table method,50 cases in each group.All study subjects received life intervention and health education.The control group was given routine treatment during pregnancy(antihypertensive,antispasmodic,sedative,timely termination of pregnancy,etc.),while the observation group was given routine treatment during pregnancy and was divided into three subgroups:A,B,and C:group A combined with routine calcium plus low-dose aspirin therapy,group B combined with folic acid plus vitamin B_(12) therapy,group C combined with nadroparin calcium therapy.Observation indicators after treatment include coagulation function monitoring[plasma prothrombin time(PT),activated partial thrombin time(APTT),D-dimer(DD)],ambulatory blood pressure monitoring(mean arterial pressure(MAP)]and 24 h urine protein quantification.The umbilical artery ratio of the maximum blood flow velocity at systolic stage to the blood flow velocity of diastasis(S/D)and resistance index(RI)were measured by three-dimensional color Doppler ultrasound.The pregnancy outcome of each pregnant woman was counted.Results Before treatment,there was no significant difference in coagulation function among all groups(P>0.05).After treatment,PT and APTT in group A,B and C were higher than the control group,and DD was lower than the control group,with statistical significance(P<0.05).Intra-group comparison:PT and APTT in group C were higher than groups A and B,and DD was lower than group A and B,with statistically significant(P<0.05),but there was no significant difference in PT,APTT and DD between group A and group B(P>0.05).Before treatment,MAP and 24 h urinary protein quantification were not statistically significant among all groups(P>0.05),after treatment,MAP and 24 h urinary protein quantification in group A,B and C were significantly lower than the control group(P<0.05).Intra-group comparison:MAP and 24 h urinary protein quantification in group C was lower than group A and B,with statistically significant(P<0.05),but there was no statistically significant difference in MAP and 24 h urinary protein quantification between group A and group B(P>0.05).Before treatment,there was no significant difference in S/D and RI among all groups(P>0.05),after treatment,S/D and RI in group A,B and C were lower than the control group,with statistically significan(t P<0.05).Intragroup comparison:S/D and RI in group C were lower than group A and B,with statistically significant(P<0.05),but there was no significant difference in S/D、RI between group A and group B(P>0.05).The incidence of cesarean section and neonatal asphyxia in the observation group was lower than the control group,and the incidence of birth weight gain and prolonged expectant treatment time was higher than the control group,with statistically significant(P<0.05).Conclusion The drug intervention in HDP patients can effectively controle blood pressure level,improve their coagulation function,stabilize artery blood flow and improve pregnancy outcomes.However,short-term treating with heparin is more effective and safer than other drugs.
作者
周燕
雷丽群
林坤海
曾靖燕
ZHOU Yan;LEI Li-qun;LIN Kun-hai(Department of Obstetrics,Yangjiang Maternal and Child Health Hospital,Yangjiang 529500,China)
出处
《中国处方药》
2023年第10期122-125,共4页
Journal of China Prescription Drug
基金
阳江市医疗卫生类科技计划项目(SF2020088)。
