胃肠外科新生儿围术期凝血功能异常的影响因素分析

Analysis of influencing factors of perioperative coagulation dysfunction in neonates with gastrointestinal surgery

目的分析胃肠外科新生儿围术期凝血功能异常的影响因素。方法回顾性分析2012年6月至2016年4月胃肠外科323例新生儿凝血指标,包括血浆凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、凝血酶时间(TT)和血浆纤维蛋白原(Fib)以及围术期相关临床资料,分析围术期凝血功能异常相关危险因素。结果术后4h内凝血指标异常新生儿158例,其中轻度异常61例,明显异常97例。多元Logistic回归分析显示,术前合并肺炎(OR=2.880,95%CI 1.417~5.852)、围术期低钙(OR=2.381,95%CI 1.167~4.857)、有创穿刺置管(OR=2.490,95%CI 1.299~4.773)是新生儿术后4h内凝血指标异常的独立危险因素(P<0.05)。结论在围术期管理时,应积极治疗肺炎、纠正低钙血症及选用浓度低于6.25U/ml的肝素溶液或生理盐水护理动静脉,以减少新生儿术后凝血功能异常的发生。

Objective To analyze the influencing factors of perioperative coagulation dysfunction in neonates with gastrointestinal surgery.Methods Coagulation indexs,including plasma prothrombin time（PT）,partial activated thromboplastin time（APTT）,thrombin time（TT）and plasma fibrinogen（Fib）,were collected retrospectively from June 2002 to April 2016 in gastrointestinal neonatal surgery,as well as perioperative clinical data and the perioperative coagulation dysfunction associated risk factors were analyzed.Results There were 158 cases with abnormal coagulation indexs within 4hours after operation,including 61 cases of mild abnormalities and 97 cases of obvious abnormalities.Multivariate logistic regression analysis showed that preoperative pneumonia（OR=2.880,95%CI 1.417-5.852）,perioperative low calcium（OR=2.381,95%CI 1.167-4.857）and invasive puncture catheter（OR=2.490,95%CI 1.299-4.773）were independent risk factors for neonatal coagulation index abnormality within 4hours after surgery（P〈0.05）.Conclusion In the perioperative management,pneumonia should be actively treated,correcting hypocalcemia and choosing concentrations of less than 6.25U/ml of heparin solution or normal saline careing arteriovenous catheter reduces the occurrence of neonatal postoperative coagulation dysfunction.