正常妊娠妇女不同孕期凝血指标变化及其临床意义探讨

Investigation on changes of coagulation indicators during different pregnant periods in normal pregnant women and their clinical significance

目的观察正常妊娠妇女不同孕期的凝血指标变化并探讨其临床意义。方法使用法国STAGO Compact全自动血凝仪,分别在孕中、孕晚及临产期测定207例正常妊娠妇女的凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)及纤维蛋白原(FIB),以205例同期健康体检的育龄期妇女为对照,比较其各项凝血指标的变化情况。结果正常妊娠组与非孕对照组相比,APTT、PT、INR、TT明显缩短,FIB水平明显升高;孕晚期APTT、PT和INR较孕中期和临产期明显缩短;临产期TT较孕中期及孕晚期明显缩短,孕中、晚期差异则无统计学意义(P>0.05);孕晚期、临产期FIB水平较孕中期明显升高,孕晚期、临产期比较差异则无统计学意义(P>0.05)。结论正常妊娠期妇女随孕期的延长,血浆处于高凝状态。定期动态监测凝血指标,可及时了解体内凝血功能状况,对预防和治疗产中、产后异常出血及产科并发症具有重要的临床意义。

Objective To observe the changes of the coagulation indicators during different pregnant periods in normal pregnant women and to explore their clinical significance. Methods The Stago Compact automatic blood coagulation analyzer was used to de- tect the prothrombin time（PT）, international normalized ratio（INR）, activated partial thromboplastin time（APTT）, thrombin time （TT） and fibrinogen（FIB） at middle pregnancy, late pregnancy and parturient period in 207 normal pregnant women. Contemporaneous 205 child-bearing period women under going healthy physical examination were taken as the controls. The changes of various coagulation indicators were compared. Results Compared with non-pregnancy control group, APTT, PT, INR and TT in the normal pregnancy group were significantly shortened,the FIB level was significantly increased; APTT, PT and INR in the late pregnancy were significantly shortened compared with the middle pregnancy and parturient period;TT in the parturient period was significant- ly shortened compared with middle pregnancy and late pregnancy,the difference between the middle pregnancy and late pregnancy had no statistical significance（P〈〉0.05） ;the FIB level in late pregnancy and parturient period was significantly increased compared with middle pregnancy, while the difference between late pregnancy and parturient period had no statistical significance（P〈0.05）. Conclusion With the extension of pregnancy in normal pregnant women, plasma is in hypercoagulable state. Dynamic monitoring coagulation indicators at regular intervals can timely understand the coagulation function status and has an important clinical significance for preventing and treating bleeding during delivery,postpartum abnormal bleeding and obstetric complications.