正常妊娠凝血纤溶功能及血流动力学特点的序贯观察

A Perspective Study of Coagulative,Anticoagulative,Fibrinolyic and Hymodynamic Indexes in Normal Pregnancy

目的探讨正常妇女妊娠早、中、晚三期凝血系统和血流动力学系统相关指标的变化规律。方法选取38例正常妊娠者为观察组，另选取40例正常未孕者为对照组。正常妊娠组分别于妊娠早期（10～14周）、妊娠中期（20～24周）及妊娠晚期（30～34周）采集血样测定凝血4项[包括凝血酶时间（TT）、活化部分凝血活酶时间（APTF）、凝血酶原时间（盯）及纤维蛋白原（Fg）]、D-二聚体、人凝血酶原片段（F1＋2）和纤溶酶原激活剂抑制物-2（PAI-2），并行彩色多普勒超声测定子宫动脉血流收缩期最大血流速度与舒张末期血流速度的比值（S／D）、脉搏指数（PI）、阻力指数（RI）。结果观察组凝血常规指标、F1＋2、PAI-2、D-二聚体与对照组比较差异有统计学意义（P〈0．05），妊娠后PAI-2、D-二聚体呈上升趋势；观察组子宫动脉S／D、PI、RI与对照组比较差异均有统计学意义（P〈0．05），且妊娠中、晚期下降明显。结论随着妊娠进展，凝血纤溶系统功能逐渐加强，在新的水平上达到平衡；子宫动脉血流阻力逐渐降低，利于胎儿胎盘循环。

Objective To investigate the sequential regulation of normal pregnancy on coagulation- fibrinolytic system and hemo-dynamics uterine ateries. Methord 38 normal pregnant women were enrolled as study group and 40 non-pregnant women as control group. Venous blood was obtained from the pregnant women in 10- 14 weeks, 20-24 weeks and 30 -34 weeks. Measurements of PT, APTT, TT and FgF1 ＋2, PAI-2 and DD as well as Dopple were adopted in both groups Results F1 ＋2, PAI-2 and DD are increased during pregnant period, especially during the second trimenster. Common Coagulation paremeters also turn to be a hy- per-coagulation state as the of the gestation weeks increase. And uterine arteries＇ RI PI S/D are decreasing with increasing of gestation weeks. Conclusion The study suggests that pregnant period is an hyper-coagulate state. Common coagulate parameters and special parameters, such as F1 ＋2, PAI-2 and DD change during preg- nant period, especially in second trimenster. There are no correlations between coagulation-fibrinolytic parame- ters and hemo-dynamics in kidney, uterine or umbilical arteries.