摘要
目的:探讨高压氧联合小剂量低分子肝素(LMWH)治疗对早发型子痫前期(PE)患者血管内皮功能和妊娠结局的影响。方法:前瞻性选取2022年3月至2024年3月陕西省人民医院产科收治的90例PE患者为研究对象,按照随机数字表法分为观察组和对照组,每组45例。2组患者均进行常规解痉、降压和镇静等治疗。对照组患者皮下注射小剂量低分子肝素钠,观察组患者在此基础上联合高压氧治疗。比较2组患者治疗前后血压、凝血功能指标[血清纤维蛋白原(Fib)、D-二聚体(D-dimer)、活化部分凝血活酶时间(APTT)及凝血酶原时间(PT)]、血管内皮功能指标[内皮素-1(ET-1)、一氧化氮(NO)、胎盘生长因子(PLGF)及可溶性内皮因子(sEng)]以及妊娠结局。结果:与治疗前比较,治疗后2组患者血压均明显下降,且观察组[(121.63±14.62)/(83.92±7.46)mmHg]明显低于对照组[(139.23±15.21)/(93.53±8.52)mmHg],差异均有统计学意义(均P<0.001);Fib、D-dimer水平均明显下降,APTT、PT均明显延长,且观察组患者Fib、D-dimer水平[(2.41±0.57)g/L、(1.42±0.26)mg/L]均明显低于对照组[(3.76±0.61)g/L、(2.15±0.33)mg/L],APTT、PT[(34.61±5.03)s、(16.41±1.33)s]均明显长于对照组[(30.92±4.63)s、(13.32±1.40)s],差异均有统计学意义(均P<0.001);血清ET-1、sEng水平均明显下降,NO、PLGF水平均明显升高,且观察组患者血清ET-1、sEng水平[(65.36±5.97)ng/L、(2.14±0.52)μmol/L]均明显低于对照组[(72.30±6.13)ng/L、(2.73±0.63)μmol/L],NO、PLGF水平[(53.01±5.39)μmol/L、(45.81±6.03)ng/L]均明显高于对照组[(44.93±6.03)μmol/L、(40.24±4.07)ng/L],差异均有统计学意义(均P<0.001)。观察组患者不良妊娠结局总发生率为11.11%,明显低于对照组(28.89%),差异有统计学意义(P<0.05)。结论:高压氧联合小剂量低分子肝素治疗能降低早发型PE患者的血压,改善其血管内皮功能及妊娠结局。
Objective To investigate the efficacy of hyperbaric oxygen(HBO)combined with low-dose low molecular weight heparin(LMWH)on vascular endothelial function and pregnancy outcomes in patients with early-onset preeclampsia(PE).Methods A total of 90 patients with PE admitted to the Department of Obstetrics of Shaanxi Provincial People’s Hospital from March 2022 to March 2024 were selected as the study objects,and divided into observation group and control group according to the random number table method,with 45 cases in each group.Both groups of patients received conventional treatments such as antispasmodic,antihypertensive,and sedative therapies.The control group received subcutaneous injections of low-dose low molecular weight heparin sodium,while the observation group received HBO therapy in addition to the treatment given to the control group.The blood pressure,coagulation function indicators[serum fibrinogen(Fib),D-dimer(D-dimer),activated partial thromboplastin time(APTT),and prothrombin time(PT)],vascular endothelial function indicators[endothelin-1(ET-1),nitric oxide(NO),placental growth factor(PLGF),and soluble endoglin(sEng)],and pregnancy outcomes were compared between the two groups before and after treatment.ResultsCompared with before treatment,blood pressure in both groups significantly decreased after treatment,with the observation group[(121.63±14.62)/(83.92±7.46)mmHg]showing lower values than the control group[(139.23±15.21)/(93.53±8.52)mmHg],the differences were statistically significant(all P<0.001).Fib and D-dimer levels significantly decreased,APTT and PT significantly prolonged,and the observation group had lower Fib and D-dimer levels[(2.41±0.57)g/L,(1.42±0.26)mg/L]than the control group[(3.76±0.61)g/L,(2.15±0.33)mg/L],and longer APTT and PT[(34.61±5.03)s,(16.41±1.33)s]than the control group[(30.92±4.63)s,(13.32±1.40)s],with statistically significant differences(all P<0.001);serum ET-1 and sEng levels significantly decreased,NO and PLGF levels significantly increased,and the observation group had lower serum ET-1 and sEng levels[(65.36±5.97)ng/L,(2.14±0.52)µmol/L]than the control group[(72.30±6.13)ng/L,(2.73±0.63)µmol/L],and higher NO and PLGF levels[(53.01±5.39)µmol/L,(45.81±6.03)ng/L]than the control group[(44.93±6.03)µmol/L,(40.24±4.07)ng/L],with statistically significant differences(all P<0.001).The total incidence of adverse pregnancy outcomes in the observation group was 11.11%,which was significantly lower than that in the control group(28.89%),with a statistically significant difference(P<0.05).ConclusionHBO combined with low-dose LMWH can reduce blood pressure,and improve vascular endothelial function and pregnancy outcomes in patients with early-onset PE.
作者
张晓姗
秦利
张凌燕
董千靖
薛宝瑶
Zhang Xiaoshan;Qin Li;Zhang Lingyan;Dong Qianjing;Xue Baoyao(Department of Obstetrics,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)
出处
《中华航海医学与高气压医学杂志》
2025年第5期517-522,共6页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
基金
陕西省重点研发计划项目(2022SF-458)。
关键词
子痫前期
高压氧
低分子肝素
血管内皮功能
妊娠结局
Preeclampsia
Hyperbaric oxygen
Low molecular weight heparin
Vascular endothelial function
Pregnancy outcome
