普通肝素防治胎盘早剥早产儿凝血功能障碍/弥散性血管内凝血的效果  

Effect of Unfractionated Heparin in Prevention of Coagulation Disorders/Disseminated Intravascular Coagulation in Placental Abruption Preterm Infants

作　　者：许靖[1,2] 李秋平[2] 孔祥永[2] 韩栋[3] 孔令凯[2] 陈冲[2] 封志纯[2] 

机构地区：[1]南方医科大学附属八一临床医学院八一儿童医院新生儿重症监护中心,北京100007 [2]北京军区总医院附属八一儿童医院新生儿重症监护中心,北京100007 [3]南方医科大学生物统计学系,广州510515

出　　处：《实用儿科临床杂志》2012年第18期1439-1442,共4页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(30973210;81070524);首都特色临床医学技术发展研究项目(Z090507017709001)

摘　　要：目的探讨胎盘早剥早产儿使用普通肝素防治凝血功能异常的最合理剂量。方法纳入60例胎盘早剥早产儿,随机分为3组,分别给予不同剂量普通肝素。A组用0.1 mg·kg-1普通肝素、B组用0.2 mg·kg-1普通肝素、C组用0.3 mg·kg-1普通肝素。给药方法:入院24 h,每6 h 1次;入院24～48 h,每8 h 1次;入院48～72 h,每12 h 1次;72 h后每日1次至停用,或直接停用普通肝素。检测入院未使用普通肝素时及使用普通肝素24 h、72 h凝血功能及血小板计数,记录临床体征。结果 3组早产儿颅内出血、坏死性小肠结肠炎、新生儿黄疸、住院天数、治愈率比较差异均无统计学意义(Pa>0.05)。A组、B组、C组使用普通肝素24 h凝血功能检测值及血小板计数比较差异均无统计学意义(Pa>0.05);A组、B组、C组使用普通肝素72 h凝血功能检测值及血小板计数差异均无统计学意义(Pa>0.05);各项指标在各组使用普通肝素前、使用24 h、72 h之间比较,活化部分凝血酶原时间差异均有统计学意义(Pa<0.05);凝血酶原时间在A组、B组用药前后差异均有统计学意义(Pa<0.05);D-二聚体、纤维蛋白原在A组用药前后差异均有统计学意义(Pa<0.05);血小板计数在C组用药前后差异均有统计学意义(Pa<0.05)。结论普通肝素0.1 mg·kg-1是胎盘早剥早产新生儿防治凝血功能异常的最合理剂量,0.1～0.3 mg·kg-1剂量均安全、有效。Objective To evaluate what＇s the most reasonable dose of unfractionated heparin to prevent the coagulation disorders in the preterm placental - abrnption newborns. Methods Sixty preterm placental - abruption newborns were included and divided randomly into 3 groups receiving different doses ： 0.1 mg ·kg-1 unfractionated heparin in group A, 0.2 mg·kg-1 unfraetionated heparin in group B, and 0.3 mg·kg-1 unfractionated heparin in group C, and they all were administered like that： the first 24 h was q 6 h,the second 24 h was q8h,the third 24 h was q12h, and transition to the withdrawal by qd or withdrawal at the fourth 24 h and later. At the same time of every transitioning administration, coagulation function markers and platelet count were detected. The clinical signs were recorded during the course. Results Such complications as intracranial hemorrhage, necrotizing enterocolitis, neonatal jaundice, hospital duration （ days ） , the cure rate were not statistically different among the 3 groups （Pa 〉 0. 05 ） ;the coagulation testing values and platelet count at 24 h and 72 h after administering unfractionated heparin were not statistically different （ Pa 〉 0.05 ） among the 3 groups. The activated partial thromboplastin time at 24 h and 72 h after administering unfractionated heparin of every groups were statistically significant （P 〈 O. 05 ） in every group, prothrombin time 24 h and 72 h after administering unfractionated heparin in group A and group B were statistically significant （ Pa 〈 0.05 ）, D - dimer and fibrinogen at 24 h and 72 h after administering nnfractionated heparin in group A were statistically significant （Pa 〈0.05） ,platelet count at 24 h and 72 h after administering unfractionated heparin in group C were statistically significant （Pa 〈 0.05 ）. Conclusions The dose of 0.1 mg·kg-1 is most reasonable for preterm placental - abruption newborns to prevent the coagulation abnormalities progressing, and the scope of 0. 1 - 0.3 mg ·kg-1 is safe and effecti

关 键 词：胎盘早剥 凝血功能 婴儿 新生 

分 类 号：R722.6[医药卫生—儿科]