产前应用维生素K_1预防早产儿脑室周围-脑室内出血的研究  

Prevent for peri-intraventricular hemorrhage in preterm infant by maternal prenatal administration of vitamin K1

作　　者：田春莉[1] 王德亮[1] 齐风芹[1] 徐雪莲[1] 彭富栋[1] 

机构地区：[1]聊城市第二人民医院儿科,山东临清252600

出　　处：《中国小儿急救医学》2006年第5期429-430,442,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的了解早产儿是否存在维生素K(VitK)依赖因子水平低下及其与早产儿脑室周围-脑室内出血的关系,探讨产前应用VitK1对早产儿脑室周围-脑室内出血的预防效果。方法将有可能早产且至分娩时孕周不足34周的孕妇分为两组:地塞米松(Dex)组118例,在产前给予Dex注射;Dex+VitK1组80例,产前给予Dex及VitK1。两组早产儿各40例留取脐动脉血离心取血清-20℃保存,用凝固法检测凝血因子II、VIII、X、X的活性,同时留取同期出生的健康足月新生儿40例脐血标本作对照。早产儿生后1周内常规做头颅超声检查明确有无脑室周围-脑室内出血及其程度。结果Dex组脐血VitK依赖因子II、VII、IX、X的活性水平分别为(25.1±10.4)%(、58.1±16.9)%(、23.8±9.8)%(、29.6±8.7)%,Dex+VitK1组分别为(36.2±9.4)%、(69.3±17.1)%、(25.4±10.1)%(、39.8±9.1)%,足月儿分别为(37.1±5.9)%(、65.8±13.5)%(、29.7±7.3)%、(37.6±11.3)%。Dex组与足月儿组比较,VitK依赖因子活性水平有显著性差异(P<0.05)。Dex组与Dex+VitK1组比较,II、VII、X因子活性水平有显著性差异(P<0.05)。脑室周围-脑室内出血发生率Dex组为52.5%,Dex+VitK1组为32.5%(χ2=7.76,P<0.05);重度出血发生率Dex组为12.7%,Dex+VitK1组为2.5%(χ2=6.33,P<0.05)。结论早产儿存在VitK依赖因子水平低下,可能是其易于发生脑室周围-脑室内出血的原因之一。分娩前母亲补充VitK1可显著提高其血浆II、VII和X因子水平,并对脑室周围-脑室内出血有一定预防作用。Objective To investigate the relationship between the low concentrations of vitamin K-dependent coagulation factors and the peri-intraventricular hemorrhage （PIVH） in preterm infant, and the effect of maternal prenatal administration of vitamin K on preventing PIVH in preterm infants. Methods Pregnant women of preterm labor at less than 34 weeks of gestational age were randomly divided into two groups： Dex group had 118 cases which were given Dex injections; Dex ＋ VitK1 group had 80 cases which were given Dex ＋ VitK1. During the same period, forty full-term neonates were as control. Cord blood samples of three groups were obtained to determine coagulation factors Ⅱ, Ⅶ, Ⅸ and Ⅹ. The cranial, ultrasound was performed by a same physician to detect whether the neonates were complicated with PIVH and to determine its severity. Results The activities of Vitamin K-dependent coagulation factors were Ⅱ（25.1 ± 10.4）%, Ⅶ（58.1 ± 16.9） %, Ⅸ（23.8± 9.8） %, Ⅹ（29.6±8.7） % in Dex group, were Ⅱ（36.2± 9.4） %,Ⅶ（69.3± 17.1） %, Ⅸ（25.4± 10.1）%,Ⅹ（39.8±9.1）% in Dex＋VitK1 group and were Ⅱ（37.1 ±5.9）%,Ⅶ（65.8± 13.5） %, Ⅸ（29.7 ± 7.3） %, Ⅹ（37.6 ± 11.3） % in full-term group. The levels of Vitamin K-dependent coagulation factors in umbilical blood had significant difference between the Dex group and the full-term infants （P 〈 0.05）. The levels of coagulation factors Ⅱ, Ⅶ, Ⅸ were higher significanty in Dex ＋ VitK1 group than that in Dex group （ P 〈 0.05）. The total incidence of PIVH in Dex ＋ VitK1 group and Dex group were 32.5 % and 52.5 %, respectively（ P 〈 0.05）, and the frequencies of severe PIVH in two groups were 2.5 % and 12.7 %, respectively（P 〈 0.05）. Conclusion Preterm infants have decreased activities of Vitamin K-dependent coagulation factors which is one of the reasons of PIVH. Prophylactic administration of Vitamin K1 to pregnant women can improve the activities of Vitamin K-dependent coagulation f

关 键 词：婴儿 早产 维生素K1 颅内出血 

分 类 号：R714.7[医药卫生—妇产科学] R722.6[医药卫生—临床医学]