硝苯地平联合依诺肝素钠对重度子痫前期术后患者妊娠期高血压的影响

Effects of Nifedipine Combined with Enoxaparin Sodium on Hypertension During Pregnancy in Patients with Severe Preeclampsia

关键词:  硝苯地平  依诺肝素钠  重度子痫前期  凝血功能  D-二聚体

Key words:  nifedipine  enoxaparin sodium  severe preeclampsia  coagulation function  D-dimer

摘要:

目的 探讨联合应用硝苯地平与依诺肝素钠治疗对重度子痫前期术后患者血压、凝血功能及对血清D-二聚体的影响。方法 选取2015年6月-2017年10月期间行宫剖产术进行分娩的203例重度子痫前期孕妇，依据随机对照表分为对照组（101例）和观察组（102例）。对照组采用硝苯地平治疗，观察组采用硝苯地平联合依诺肝素钠治疗，比较2组患者采用不同方式治疗后血压、凝血功能的变化情况，以及对血清D-二聚体的影响，并统计不良妊娠结局。结果 观察组总体有效率为95.10%，显著高于对照组（87.13%），具有统计学差异（P<0.05）。观察组治疗后FIB、D-二聚体、PAI-1、HB、PLT显著降低，而PT、APTT、t-PA均显著增加，各指标水平显著优于对照组（P<0.05）。治疗后2组患者的收缩压、舒张压均显著降低，且治疗后观察组各血压水平显著低于对照组（P<0.05）。治疗后2组患者的血清vWF、PAPP-A水平均显著降低，其中观察组各水平显著低于对照组（P<0.05）。观察组平均妊娠时间、胎儿体质量均显著优于对照组，24 h蛋白尿水平显著低于对照组，主要不良妊娠结局为胎儿窘迫、早产、产后出血、新生儿窒息，其中观察组不良妊娠发生率（9.80%）显著低于对照组（18.81%），具有统计学差异（P<0.05）。结论 硝苯地平联合依诺肝素钠对重度子痫前期治疗效果显著，可有效降低患者术后血压，改善凝血功能，调节血清D-二聚体水平，从而降低不良妊娠结局发生率。

Abstract:

OBJECTIVE To explore the effects of nifedipine combined with enoxaparin sodium on blood pressure, coagulation function and serum D-dimer in patients with severe preeclampsia. METHODS The 203 pregnant women with severe preeclampsia who were delivered by cesarean section were selected from June 2015 to October 2017. According to the random comparison table, they were divided into control group (101 cases) and observation group (102 cases). The control group was treated with nifedipine, while the observation group was treated with nifedipine combined with enoxaparin sodium. The changes of blood pressure, coagulation function and serum D-dimer were compared between the two groups, and the adverse pregnancy outcome were analyzed. RESULTS The total effective rate of observation group was 95.10%, significantly higher than that of control group(87.13%), with statistical difference(P<0.05). After treatment, FIB, D-dimer, PAI-1, HB, PLT decreased significantly in the observation group, while PT, APTT, t-PA increased significantly, and the level of each index was better than that in the control group(P<0.05). After treatment, the systolic and diastolic blood pressures of the two groups were significantly decreased, and the blood pressure level of the observation group was significantly lower than that of the control group (P<0.05). After treatment, the serum vWF and PAPP-A levels in both groups were significantly decreased, and the levels in the observation group were significantly lower than those in the control group(P<0.05). The mean gestational time and fetal weight in the observation group were significantly better than those in the control group, and the 24-hour proteinuria level in the observation group was significantly lower than that in the control group. The main adverse pregnancy outcomes were fetal distress, premature delivery, postpartum hemorrhage, neonatal asphyxia. The incidence of adverse pregnancy in the observation group (9.80%) was significantly lower than that in the control group (18.81%), with statistical difference(P<0.05). CONCLUSION Nifedipine combined with enoxaparin sodium is effective in the treatment of severe preeclampsia. It can effectively reduce postoperative blood pressure, improve coagulation function, regulate serum D-dimer level after operation, thereby reducing the incidence of adverse pregnancy outcome.