胎盘早剥对新生儿凝血功能的影响及临床意义

Impacts of placental abruption on coagulation function of the neonate and their clinical significances

目的探讨胎盘早剥对新生儿凝血功能的影响及其临床意义。方法抽取25名胎盘早剥新生儿（按，临床分度标准分为轻、重型两组）生后2、6、18、36小时的血液标本，检测凝血酶原时间、活化部分凝血活酶时间、D-二聚体、纤维蛋白原和血小板计数，另设对照组15名。结果与其他两组比较，重型组5项凝血指标生后6小时内即出现明显异常，凝血酶原时间和活化部分凝血活酶时间延长，D．二聚体上升，纤维蛋白原和血小板计数下降；轻型组与对照组对比，在生后18小时前各凝血指标均无明显差异，而后则逐渐出现差异。重型组与轻型组比较提示两者各指标存在显著性差异（活化部分凝血活酶时间：F=4．713，P=0．015；凝血酶原时间：F=2．810，P=0．045；D-二聚体：F=3．687，P=0．003；血小板计数：F=4．634，P=0．002；纤维蛋白原：F=5．883，P=0．000）。结论胎盘早剥易致新生儿凝血功能紊乱，重型组较轻型组患儿出现时间早、程度重，临床上应予早期治疗，并监测凝血指标，特别是轻型病例。

Objective To investigate impacts of placental abruption on coagulation function of the neonate so as to provide valuable evidences for early clinical intervention and treatment. Methods 25 neonates whose mother underwent placental abruption and they admitted to NICU in our hospital from October, 2008 to February, 2009 were selected and were divided into two groups： severe placental abruption group and mild placental abruption group according to size of abrupted area of the placenta. 15 normal neonates were as controls. The blood samples of all neonates were taken at 2, 6, 18 and 36 hours after birth for detection of prothrombin time（PT）, activated partial thromboplastin time（APTT）, D-dimer（ D-D）, fibrinogen （Fig） and platelet count （PLT） respectively. Results As compared with other two groups, five coagulation indexes of the neonates in the severe placental abruption group were abnormal within 6h after birth significantly： APTr, PT were prolonged and D-D was increased, PLT and Fig declined. Within 18h after birth, in 5 coagulation indexes there were no significant differences between mild placental abruption group and the control group, but the differences were gradually became significant thereafter. There were significant differences in all 5 items of coagulation indexes between the severe placental abruption group and the mild placental abruption （ FAPTT = 4.713, PAPTT = 0. 015 ; FPT = 2.810, PPT = 0. 045 ; FD-D = 3. 687, PD-D = 0. 003 ; FPLT = 4. 634, PPLT = 0.002; FFig = 5. 883, PFig = 0.000）. Conclusion Placental abruption may cause coagulation dysfunction of the neonate after their birth and the coagulation dysfunction of those neonates in the severe placental abruption group showed earlier and more severe than those in the mild placental abruption group. Clinically, those neonates should be treated as early as possible, and their blood coagulation indexes should be suppervised, especially for those neonates whose mother underwent mild placental abruption.