摘要目的 探讨低分子肝素(LMWH)联合小剂量阿司匹林(LDA)疗法在预防双胎妊娠合并高危因素产妇并发子痫前期中的临床价值.方法 选取山西省荣军医院2013年1月至2017年12月诊治的双胎妊娠合并子痫前期高危因素病例为研究对象,按照建档顺序编号(对应随机数)并根据随机数字表法分为两组,观察组(n=53)采用LMWH联合LDA预防子痫前期,对照组(n=53)采用LDA预防子痫前期,比较两组子痫前期发生情况与妊娠结局.结果 观察组重度子痫前期发生率为5.7％,低于对照组的18.9％(χ2=4.296,P<0.05);两组分娩孕周情况差异有统计学意义(χ2=7.993,P<0.05);两组子痫前期、胎盘早剥、产后出血和胎儿生长受限(FGR)发生情况均差异无统计学意义(均P>0.05).观察组新生儿转新生儿重症监护病房(NICU)率为18.3％,低于对照组的30.7％(χ2=4.289,P<0.05);两组围生儿病死率、新生儿窒息发生率均差异无统计学意义(均P>0.05).结论 与单一使用LDA相比,LMWH联合LDA预防能够有效降低双胎妊娠合并高危因素产妇重度子痫前期的发生率,推迟双胎产妇终止妊娠时间,并降低新生儿转NICU率.

abstractsObjective To explore the clinical value of low molecular weight heparin(LMWH) plus low dose aspirin(LDA) in preventing twin pregnancy with preeclampsia high risk factors.Methods From January 2013 to December 2017,the twin pregnancy cases with preeclampsia high risk factors who were diagnosed in Shanxi Rongjun Hospital were randomly divided into two groups according to the order of the treatment .The observation group(n=53) used LMWH plus LDA to prevent preeclampsia ,while the control group ( n=53) used LDA alone.The incidence of preeclampsia and pregnancy outcome were compared between the two groups .Results The incidence of severe preeclampsia in the observation group(5.7％) was lower than that in the control group (18.9％)(χ2 =4.296,P<0.05),and there was statistically significant difference in the delivery time between the two groups (χ2 =7.993,P<0.05).While the incidence of preeclampsia ,placental abruption,postpartum hemorrhage and FGR between the two groups had no statistically significant differences (all P >0.05).The proportion of NICU transferred fetus in the observation group(18.3％) was lower than that in the control group (30.7％)(χ2 =4.289,P<0.05).There were no statistically significant differences in perinatal mortality and neonatal asphyxia ( all P >0.05 ).Conclusion Compared with using the LDA alone , LMWH plus LDA prevention can effectively reduce the incidence of severe preeclampsia in twin pregnancies;at the same time,it also can delay the delivery time and reduce the rate of NICU transferred.