临产孕妇的凝血功能指标分析及诊断产后大出血的效能评价  

The Analysis of pregnant women’s coagulation function indicators and efficiency evaluation on diagnosis of postpartum hemorrhage

作　　者：高文静[1] 黎灼滔[1] 钟方毅[1] 曾淑敏[1] 乔杰[1] 钟敏玲[1] 欧阳群[1] 汤好[1] 

机构地区：[1]广东省东莞市莞城医院检验科,523000

出　　处：《中国医疗前沿》2013年第11期83-84,共2页China Healthcare Innovation

摘　　要：目的分析临产孕妇的产前凝血功能检查指标,探讨这些指标与产后大出血的相关性。方法选取2011年3月-2012年3月间本院临产产妇183例,另选取非孕产妇158例作为对照组。收集两组的纤维蛋白原(Fg)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、D-二聚体(DD)、抗凝血酶Ⅲ(AT-Ⅲ)等出凝血功能检查指标和临床资料。分析两组间及孕产妇组内产后出血组与非出血组间实验室检查指标差异性。结果 PT、TT、AT-Ⅲ明显低于对照组,Fg和DD水平明显高于对照组;发生了产后大出血的孕妇的出凝血指标Fg、DD及AT-Ⅲ与未发生产后大出血的孕妇组相比差异具有统计学意义(P<0.05),以Fg≥7.00g/L来诊断产后大出血,其阳性预测值是87.5%,阴性预测值是82.3%;以AT-Ⅲ≤205mg/L,其阳性预测值是85.7%,阴性预测值是82.0%;而以DD≥650mg/L,其阳性预测值和阴性预测值均是100%。结论临产孕妇的凝血功能指标与非孕产妇相比有显著差别,根据产前监测Fg、DD及AT-Ⅲ的浓度水平对预测产妇产后大出血有重要意义。Objective To analyze the indicators of coagulation function in pregnant women and evaluate the correlation between the indicators of coagulation function in pregnant women and the postpartum hemorrhage.Methods 183 cases of pregnant women were selected from March 2011 to March 2012 in our hospital as the research object,158 cases of healthy pregnant women were checked up in the same period in our hospital as the control group.Fibrinogen（Fg） level,prothrombin time（PT）,thrombin time（TT）,activate part of thrombin time（APTT）,the d-dimmer and anticoagulant Ⅲ enzyme（AT-Ⅲ） activity of two groups were detected.Differences of laboratory parameters were analyzed within the two groups and between the group of maternal postpartum hemorrhage group and the nonbleeding group.Results The index of PT,TT was significantly shorten,AT-Ⅲ activity decreased significantly,the level of Fg and d-dimmer significantly higher than those in the control group,the difference were statistically significant（P〈0.05）.If the level of Fg≥7.00g/L was acted as the diagnosis level of postpartum hemorrhage,the positive predictive value（PPV） is 87.5% and the negative predictive value（NPV） is 82.3%.If the level of AT-Ⅲ ≤ 205mg/L,the PPV and NPV are 85.7% and 82.0% respectively.However,if the level of DD is above 650mg/L,the PPV and NPV are 100%.Conclusions The difference of coagulation parameters between the pregnant women and nonpregnant women is significant,it is important to predict postpartum hemorrhage according to the prenatal detection level of Fg,DD and AT-Ⅲ.

关 键 词：临产孕妇 凝血功能 产后大出血 

分 类 号：R446.11[医药卫生—诊断学]