作　　者： (赵娟）; (张丙宏）;

机构地区： 430000,武汉大学人民医院儿科

出　　处： 《中国医师进修杂志》

摘　　要： 目的 了解出生胎龄及体质量对新生儿凝血功能的影响.方法 收集2015年6月至2016年6月出生后即入住新生儿科的患儿共500例,记录高危因素包括高血压、糖尿病、胎膜早破、前置胎盘等,以及出生时基本情况(胎龄、体质量、分娩方式、性别).根据患儿胎龄分为早期早产儿(28~30+6周,48例),中期早产儿(31-33+6周,125例),晚期早产儿(34~36+6周,216例),及足月儿(37~42周,111例).生后6 h内检测凝血功能,包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白降解产物(FDP)、纤维蛋白原(FIB)、D二聚体(DD)、抗凝血酶Ⅲ(AT-Ⅲ),分析比较不同胎龄凝血功能差异.另将双胞胎66对,根据体质量分为体质量小组及体质量大组,比较胎龄相同情况下体质量对凝血功能的影响.结果 各组危险因素比较,差异无统计学意义(P>0.05);不同胎龄组,凝血指标[APTT:(93.25±21.34)、(82.80±21.37)、(78.29±17.77)、(62.03±13.7)s;FIB:(1.95±0.96)、(1.67±0.60)、(1.51±2.44)、(1.40±0.85)g/L;DD:(2.11±0.64)、(1.02±0.33)、(0.66±0.31)、(0.51±0.25)mg/L;AT-Ⅲ:(25.89±11.80)%、(33.86±11.40)%、(36.65±13.60)%、(45.18±14.82)%]差异均有统计学意义(P<0.05),APTT、FDP、DD均随胎龄增加呈降低趋势(P<0.05,r均<0),FIB及AT-Ⅲ则随胎龄增加呈升高趋势(P<0.05,r均>0),PT与胎龄关系不大(P>0.05).另一分组,出生体质量不同,凝血功能各指标差异无统计学意义(P>0.05).结论 新生儿出生早期凝血功能主要与胎龄有关,当胎龄相同时,各指标与体质量关系不大.需警惕胎龄对凝血功能的影响,及时复查凝血功能,预防出血性疾病的发生. Objective To understand the relationship between coagulation function and birth weight and gestational age in newborn. Methods Five hundred premature infants in NICU from June 2015 to June 2016 were enrolled. Perinatal high-risk factors(gestational hypertension, gestational diabetes, placenta previa, spontaneous premature delivery) and general status (gestational age, sex, delivery mode, birth weight)were documented. Blood coagulation function (PT, APTT, FDP, DD, FIB, AT-Ⅲ) was detected within 6 h after birth. The premature infants were divided into three groups according to gestational age, early preterm neonate group (28-30+6 weeks, 48 cases), moderate preterm neonate group (31-33+6 weeks, 125 cases), and late preterm neonate group (34-36+6 weeks, 216 cases). And there were 111 term infants (37- 42 weeks, 111 cases). In addition , the relation between birth weight and coagulation function was analyzed. Sixty-six twins were collected and divided into tow groups according to their weight, the-lighter group and the-heavier group. The coagulation function was analyzed and compared among different gestational age groups. Results There were no differences in perinatal risk factors (P > 0.05). There were significant differences in various coagulation parameters among three groups [APTT: (93.25 ± 21.34), (82.80 ± 21.37), (78.29 ± 17.77), (62.03 ± 13.7) s;FIB: (1.95 ± 0.96), (1.67 ± 0.60), (1.51 ± 2.44), (1.40 ± 0.85) g/L; DD: (2.11 ± 0.64), (1.02 ± 0.33), (0.66 ± 0.31), (0.51 ± 0.25) mg/L;AT-Ⅲ:(25.89 ± 11.80)%, (33.86 ± 11.40)%, (36.65 ± 13.60)%, (45.18 ± 14.82)%] (P<0.05). The levels of APTT, FDP, DD tended to decrease with the increasing of gestational age. The level of FIB and AT-Ⅲtended to increase with the increasing of gestational age. Correlation analysis showed that the levels of APTT, FDP, and DD were negatively correlated with gestational age (P<0.05) and the levels of FIB and AT-Ⅲwere positively correlated with gestational age (P<0.05). In the twins group, no significant difference was showed in different weight (P > 0.05). Conclusions The coagulation function in early life in premature infants is associated with gestational age, and has no relationship with birth weight. The coagulation function of premature infants is in a changing and gradually mature process, which should be monitored dynamically.

分 类 号： [Z1]