本文選題：低分子肝素鈉 + 人類輔助生殖技術(shù)��； 參考：《醫(yī)學研究生學報》2017年04期

【摘要】：目的目前針對低分子肝素(LMWH)在人類輔助生殖技術(shù)(ART)獲得妊娠后發(fā)生復發(fā)性流產(chǎn)(RSA)患者中的臨床病例研究較少。文中旨在探討LMWH在ART獲得妊娠后發(fā)生RSA婦女中的臨床應用研究。方法選擇2010年1月至2016年2月于廣東醫(yī)科大學附屬醫(yī)院生殖醫(yī)學中心進行ART治療獲得妊娠后發(fā)生RSA的患者126例。根據(jù)接受ART助孕治療的病因不同,其中子宮輸卵管造影提示至少有一側(cè)輸卵管為通暢的患者,接受宮腔內(nèi)人工授精(IUI)助孕治療;而有輸卵管疾病體外受精-胚胎移植(IVF-ET)治療。將同意采用LMWH治療的60例患者按不同治療方式分為LMWH+IUI組(接受IUI治療)、LMWH+IVF-ET組(接受IVF-ET治療),每組30例。將不同意采用LMWH治療的66例患者分為IUI組(n=32)、IVF-ET組(n=34)。比較4組患者接受ART的妊娠成功率、抱嬰率,再次發(fā)生RSA的妊娠時間、妊娠并發(fā)癥的發(fā)病率等。同時觀察LMWH使用過程中不良反應的發(fā)生情況。結(jié)果 LMWH+IUI組再次發(fā)生RSA的妊娠時間較IUI組顯著增加[(82.67±9.10)d vs(48.17±8.68)d,P0.05]。LMWH+IVF-ET組妊娠成功率、抱嬰率較IVF-ET組顯著升高[66.67%vs35.29%;85.00%vs 50.00%,P0.05],2組再次流產(chǎn)的發(fā)生率、再次發(fā)生RSA的妊娠時間、妊娠期高血壓疾病發(fā)生率差異亦有統(tǒng)計學意義(P0.05)。LMWH+IUI組、LMWH+IVF-ET組孕4周血漿D二聚體(D2D)數(shù)值[(0.65±0.07)、(0.62±0.06)mg/L]低于IUI組、IVF-ET組[(0.76±0.12)、(0.77±0.06)mg/L],LMWH+IUI組孕6周D2D值低于IUI組、IVF-ET組,LMWH+IVF-ET組低于IVF-ET組(P0.05)。4組患者的血漿D2D數(shù)值組內(nèi)比較均隨著孕周的增加而增加(P0.05)。LMWH+IUI組、IUI組和LMWH+IVF-ET組孕4周凝血酶原時間(PT)含量[(12.53±0.38)、(12.38±0.65)、(12.47±0.58)s]較孕前[(12.33±0.52)、(12.30±0.68)、(12.22±0.64)s]、孕6周[(12.13±0.62)、(12.05±0.60)、(12.03±0.54)s]明顯增高(P0.05)。LMWH+IUI組、LMWH+IVF-ET組使用LMWH的60例患者中11例出現(xiàn)臍周注射部位的皮下小面積瘀青,發(fā)生率為18.33%(11/60)。僅2例患者出現(xiàn)皮下注射部位輕度疼痛不適感,發(fā)生率為3.33%(2/60)。結(jié)論 ART獲得妊娠后發(fā)生RSA女性采用小劑量LMWH治療安全有效。
[Abstract]:Objective to study the clinical cases of low molecular weight heparin (LMWHH) in patients with recurrent abortion (RSAs) after pregnancy with human assisted reproductive technology (ART). The purpose of this study was to investigate the clinical application of LMWH in RSA women after art pregnancy. Methods 126 patients with RSA were selected from January 2010 to February 2016 in the Center of Reproductive Medicine, affiliated Hospital of Guangdong Medical University. According to the etiology of art assisted pregnancy therapy, hysterosalpingography indicated that at least one of the patients with unobstructed fallopian tube was treated with intrauterine artificial insemination IUI (IVF-ETT) and IVF-ETT with in vitro fertilization and embryo transfer of fallopian tube disease. 60 patients agreed to LMWH were divided into LMWH IUI group (IUI group) and LMWH IVF-ET group (30 cases in each group). 66 patients who did not agree to LMWH were divided into IUI group (n = 32) and IVF-ET group (n = 34). The pregnancy success rate, the infantile rate, the pregnancy time of RSA and the incidence of pregnancy complications were compared among the four groups. At the same time, the occurrence of adverse reactions during the use of LMWH was observed. Results the pregnancy time of vs(48.17 in LMWH IUI group was significantly longer than that in IUI group [82.67 鹵9.10d vs(48.17 鹵8.68dP]. The pregnancy success rate and infantile rate in LMWH IVF-ET group were significantly higher than those in IVF-ET group [66.67vs35.2955.00 vs 50.00P0.05]. There was also a significant difference in the incidence of hypertensive disorder complicating pregnancy (P0.05, LMWH IUI, LMWH IVF-ET, LMWH IVF-ET, 4 weeks gestational D _ 2D) [0.65 鹵0.07 ~ 0.62 鹵0.06 mg / L] lower than that of IUI IVF-ET [0.76 鹵0.12 mgL] LMWH IUI at 6 weeks of gestation D2D value was lower than that in IVF-ET group, LH IVF-ET group was lower than IVF-ET group, P0.05ng-1 group was lower than IVF-ET group, and the D2D value in LMWH IUI group was lower than that in IVF-ET group (0.76 鹵0.12 mgg / L). The value of D2D in LMWH IVF-ET group was lower than that in IVF-ET group and IVF-ET group was lower than that in IVF-ET group (0.76 鹵0.12 mg / L). 鐨勮嫻咲2D鏁板，

本文編號：2042879