窒息新生儿止血状态的研究

A study on hemostasis in asphyxiated newborns

为观察窒息缺氧对新生儿止血状态的影响，选择了凝血、抗凝、纤溶系统１２项指标对４１例足月窒息新生儿进行前瞻性研究，并与２１例正常足月新生儿比较。结果：窒息儿血小板计数、纤维蛋白原、抗凝血酶Ⅲ、纤溶酶原、纤溶酶、α２纤溶酶抑制物等指标均有不同程度降低，而血管性血友病因子（ｖＷＦ）、组织纤溶酶原激活物（ｔＰＡ）、纤溶酶原激活物抑制物－１（ＰＡＩ－１）、Ｄ二聚体等均有明显升高，可溶性纤维蛋白单体复合物９５％为阳性。血管内皮损伤标记物、ｖＷＦ、ｔＰＡ、ＰＡＩ－１与窒息儿血ｐＨ值呈负相关（ｒ＝－０．４７，Ｐ＜０．０１；ｒ＝－０．４６６，Ｐ＜０．０１；ｒ＝－０．３１４，Ｐ＜０．０５），且与窒息严重度一致。提示：窒息新生儿存在以高凝为主的早期ＤＩＣ，血管内皮损伤在窒息病理生理学中具重要作用。

To observe the effect of asphyxia on hemostasis of newborns. The authors prospectively studied 12 indices of coagulation, anticoagulation and fibrinolysis in 41 asphyxiated full term newborns and 21 healthy controls. The results showed that blood platelet counts, concentrations of fibrinogen and antithrombinⅢ, and activities of plasminogen, plasmin and α2 plasmin inhibilor were decreased. However, concentrations of vascular hemophiliac factor (vWF), tissue plasminogen activator (tPAI), plasminogen activator inhibitior1 (PAI1) and Ddimer were increased. Soluble fibrin monomer complex was positive in 95% of asphyxiated neonates. Markers of damaged vascular endothelial cells, vWF, tPA and PAI1 negatively correlated with blood pH (r=-0.47, P<0.01, r=-0.466, P<0.01, and r=-0.314, P<0.05, respectively). The findings of this study suggest that early DIC characterized by hypercoagulation is present in asphyxiated newborn infants. The injury of endothelial cells plays an important role in the pathophysiology of asphyxia.