中早期早产儿生后早期凝血功能异常的危险因素及结局分析

Analysis of risk factors and outcomes for abnormal coagulation in early postnatal period in early and middle-term premature infants

目的:分析中早期早产儿凝血功能与胎龄的相关性,并探讨中早期早产儿生后早期凝血功能异常的危险因素和结局。方法:回顾性分析496例早产儿生后24 h内凝血功能及临床资料,比较不同胎龄早产儿的凝血指标,分析凝血功能异常的危险因素及与颅内出血的关系。结果:不同胎龄早产儿在早期凝血功能指标活化部分凝血活酶时间、纤维蛋白原、D-二聚体(Ddimer,DD)的差异有统计学意义(P<0.05)。单因素分析凝血功能异常组患儿出生体质量、宫内窘迫、妊娠期高血压、羊水污染、动脉导管未闭、肝功能异常及血小板减少症发生的比例高于正常组,差异具有统计学意义(P<0.05)。Logistic回归分析发现,男性、宫内窘迫、动脉导管未闭和血小板减少症为独立危险因素。颅内出血组较非出血组,凝血酶原时间(prothrombin time,PT)延长(P<0.05),重度组较非出血组和轻度组DD升高(P<0.05)。结论:早产儿凝血功能随着胎龄的增长逐渐成熟,男性、宫内窘迫、动脉导管未闭和血小板减少症是早产儿凝血功能异常的危险因素,PT延长可能与颅内出血的发生有关,而DD增高则与颅内出血的严重程度有关。

Objective:To analyze the correlation between coagulation function and gestational age in early and middle-term premature infants,and to explore the risk factors and outcomes of abnormal coagulation in early postnatal period. Methods:The blood coagulation test results within 24 hours after birth and clinical data of 496 premature infants cases were retrospectively analyzed. The coagulation function parameters of these preterm infants with different gestational ages were compared,and the risk factors of abnormal coagula tion function and the relationship with intracranial hemorrhage were analyzed. Results:There were significant differences in activated partial thromboplastin time,fibrinogen and D-dimer(DD) between the two groups of preterm infants in early coagulation function parameters(P<0.05). Univariate analysis showed that the incidence of birth weight,intrauterine distress,hypertensive disorders pregnancy,meconium-stained amniotic fluid,patent ductus arteriosus(PDA),abnormal liver function and thrombocytopenia in preterm infants with abnormal coagulation function were higher than that in the normal group,with significant differences(P<0.05). Logistic regression analysis found that male,intrauterine distress,PDA and thrombocytopenia were independent risk factors. Compared with the intracranial non-bleeding group,the bleeding group had a more prolonged prothrombin time(PT)(P<0.05),and the severe group had a higher DD(P<0.05) when compared with the non-bleeding group and the mild group. Conclusion:The coagulation function of premature infants gradually matures with the increase of gestational age. Male,intrauterine distress,PDA and thrombocytopenia are risks factors of abnormal coagulation in preterm infants. PT prolongation may be related to the occurrence of intracranial hemorrhage,while DD is related to its severity.