早期新生儿凝血功能的影响因素研究

Influencing factors of coagulation function in early neonates

目的探讨早期新生儿凝血功能的影响因素。方法选取2019年11月至2023年8月西南医科大学附属医院新生儿重症监护室收治、生后6 h内完善凝血功能检测的新生儿进行回顾性分析。分别按胎龄、出生体重分组,比较不同胎龄、出生体重新生儿凝血指标的差异,并进一步采用多元线性回归分析研究早期新生儿凝血功能的影响因素。结果共纳入1265例新生儿。活化部分凝血活酶时间、凝血酶原时间及凝血酶时间随胎龄及出生体重的增长而缩短(P<0.05);多元线性回归分析显示,胎龄(β=-0.474,P<0.001)、分娩方式(β=0.106,P<0.001)、呼吸窘迫综合征(β=0.070,P=0.043)及产前阴道出血(β=0.117,P<0.001)是活化部分凝血活酶时间的影响因素;性别(β=0.077,P=0.004)、新生儿窒息(β=0.220,P<0.001)及呼吸窘迫综合征(β=0.088,P=0.033)是凝血酶原时间的影响因素;胎龄(β=-0.131,P=0.002)、分娩方式(β=0.086,P=0.002)及妊娠期高血压(β=0.188,P<0.001)是凝血酶时间的影响因素;性别(β=0.058,P=0.034;β=0.058,P=0.034)、分娩方式(β=-0.152,P<0.001;β=-0.131,P<0.001)、新生儿窒息(β=0.193,P<0.001;β=0.187,P<0.001)及胎膜早破(β=0.100,P<0.001;β=0.093,P=0.002)是纤维蛋白(原)降解产物和D-二聚体的影响因素。结论胎龄、出生体重、性别、分娩方式、新生儿窒息、呼吸窘迫综合征、妊娠期高血压、产前阴道出血及胎膜早破等均可影响早期新生儿凝血功能。

ObjectiveTo study the influencing factors of coagulation function in early neonates.MethodsFrom November 2019 to August 2023,neonates admitted to neonatal intensive care unit of our hospital receiving coagulation function tests within 6 h after birth were retrospectively analyzed.Coagulation functions were compared between neonates with different gestational ages(GA)and birth weights(BW).Multiple linear regression analysis was used to identify factors influencing early neonatal coagulation function.ResultsA total of 1265 cases were enrolled.Activated partial thromboplastin time(APTT),prothrombin time(PT)and thrombin time(TT)decreased with GA and BW(P<0.05).Multiple linear regression analysis showed that GA(β=-0.474,P<0.001),delivery method(β=0.106,P<0.001),respiratory distress syndrome(RDS)(β=0.070,P<0.043)and antenatal vaginal bleeding(β=0.117,P<0.001)were influencing factors for APTT;gender(β=0.077,P=0.004),neonatal asphyxia(β=0.220,P<0.001)and RDS(β=0.088,P=0.033)for PT;GA(β=-0.131,P=0.002),delivery method(β=0.086,P=0.002)and hypertensive disorders of pregnancy(HDP)(β=0.188,P<0.001)for TT;gender(β=0.058,P=0.034;β=0.058,P=0.034),delivery method(β=-0.152,P<0.001;β=-0.131,P<0.001),neonatal asphyxia(β=0.193,P<0.001;β=0.187,P=0.001)and premature rupture of membranes(PROM)(β=0.100,P<0.001;β=0.093,P=0.002)for fibrinogen degradation product and D-dimers.ConclusionsEarly neonatal coagulation function may be influenced by GA,BW,gender,delivery method,neonatal asphyxia,RDS,HDP,prenatal vaginal bleeding and PROM.