窒息复苏后极低出生体重儿凝血功能的监测及临床意义

Monitoring of blood coagulation function and its clinical significance after resuscitation of neonatal asphyxia for very low birth weight infant

目的观察不同程度窒息复苏后的极低出生体重儿凝血功能变化,为防治极低出生体重儿并发出血性疾病提供依据。方法将189例极低出生体重儿按出生时窒息程度分为轻度窒息58例(观察1组)、重度窒息34例(观察2组)和无窒息97例(观察3组),监测各组患儿在出生1、24、48、72h时PT、TT、APTT、纤维蛋白原(Fb)、D-二聚体5项指标变化;比较常规监测凝血功能窒息复苏后的患儿(常规监测组)与未常规监测凝血功能的窒息复苏后患儿(非常规监测组)伴出血性疾病发生率。结果观察1、2、3组患儿在出生1h时凝血5项指标差异均无统计学意义(均P>0.05);24h时观察2组Fb较观察1组和3组低,且差异均有统计学意义(均P<0.05);观察3组Fb与观察1组比高,但差异无统计学意义(P>0.05);观察2组D-二聚体较观察1组和3组高,差异均有统计学意义(均P<0.05);观察3组D-二聚体较观察1组低,但差异无统计学意义(P>0.05);48h时观察2组Fb较观察1组和3组低,且差异均有统计学意义(均P<0.05);观察3组Fb与观察1组比高,但差异无统计学意义(P>0.05);观察2组D-二聚体较观察1组和3组高,差异均有统计学意义(均P<0.05);观察3组D-二聚体较观察1组低,差异无统计学意义(P>0.05);72h时各组5项指标差异均无统计学意义(均P>0.05)。常规监测组比非常规监测组合并出血性疾病发生率低,差异有统计学意义(P<0.05)。结论窒息复苏后极低出生体重儿存在凝血功能变化,以重度窒息患儿明显,其变化是一个动态过程,建议对窒息复苏后极低出生体重儿凝血功能动态监测并适时干预。

】Objective To monitor the changes of coagulation function in the very low birth weight infants after resuscitationof neonatal asphyxia and to evaluate its clinical significance. Methods One hundred and eighty nine newborn infants with verylow birth weight admitted in Department of Neonatology from January 2013 to December 2014 were enrolled in the study,including 58 cases of mild asphyxia （group 1） , 34 cases of severe asphyxia （group 2） and 97 cases without asphyxia （group 3）.The prothrombin time, thrombin time, partial activated thrombin time, fibrinogen, and D-dimer were detected at 1h, 24h, 48h and72h after the birth. The incidence of hemorrhagic disease after asphyxia resuscitation was compared between infants withconventional monitoring of blood coagulation function （January 2013-December 2014） and without monitoring （January2011-December 2012）. Results There were no significant differences in 5 indicators of blood coagulation function at 1h afterbirth among 3 groups of infants （P〉0.05）. The fibrinogen and D-dimer in group 2 were lower than those in group 1 at 24h and48h after birth（both P〈0.05）, there were no significant differences between group 1 and group 3（P〉0.05）. However, there wereno significant differences in all 5 indicators among the 3 groups at 72h after birth（P〉0.05）. The incidence of bleeding disorders ininfants with routine monitoring was lower than that in those without routine monitoring（P〈0.05）. Conclusion There are changes ofcoagulation function in the very low birth weight infants after resuscitation for different degrees of asphyxia, particularly in thosewith severe asphyxia. The study suggests that dynamic monitoring of coagulation function and the active intervention may reducethe incidence of hemorrhagic disorders for those infants.【