影响早产儿出生时凝血功能的高危因素分析  

Risk factors affecting coagulation function in premature infants at birth

作　　者：程光清[1,2] 张森山 付扬喜 陈群 尚磊 刘俐 Cheng Guangqing;Zhang Senshan;Fu Yangxi;Chen Qun;Shang Lei;Liu Li(Department of Neonatology,The First Affiliated Hospital of Xian Jiaotong University,Xian 710061,China;Department of Neonatology,Ankang Central Hospital,Hubei Medical College,Ankang 725000,China;Department of Health Statistics,Air Force Military Medical University,Xian 710032,China)

机构地区：[1]西安交通大学第一附属医院新生儿科,710061 [2]湖北医药学院附属安康市中心医院新生儿科,725000 [3]空军军医大学卫生统计学教研室,西安710032

出　　处：《中华新生儿科杂志（中英文）》2020年第1期33-36,共4页Chinese Journal of Neonatology

摘　　要：目的了解早产儿出生时凝血功能及其影响因素,为早产儿凝血功能监测及干预提供依据。方法选择2014年1月至2018年1月安康市中心医院产科出生的早产住院患儿进行前瞻性研究。根据胎龄分为早期早产儿组、中期早产儿组、晚期早产儿组,采用自动凝血分析仪检测凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)及凝血酶时间(thrombin time,TT),分析和比较影响各组早产儿出生时凝血功能的高危因素。结果共纳入795例早产儿,早期早产儿组93例、中期早产儿组151例、晚期早产儿组551例。早期早产儿组,胎膜早破患儿FIB增高、TT缩短,重度窒息患儿PT延长,差异有统计学意义(P<O.05)。中期早产儿组,胎膜早破患儿APTT延长,差异有统计学意义(P<0.05)。晚期早产儿组,男婴PT、TT延长、FIB降低,胎膜早破患儿FIB增高,重度窒息患儿PT延长,差异均有统计学意义(P<0.05)。凝血指标影响因索的多元线性回归分析显示,新生儿窒息、体重和性别是影响PT的主要因素(P<0.05),胎龄是影响APTT的主要因素(P<0.05),胎膜早破、胎龄、体重和性别是影响FIB的主要因素(P<O.05),新生儿窒息是影响TT的主要因素(P<0.05)。结论早产儿凝血指标受性别、胎龄、体重、窒息、胎膜早破等多种因素影响,重度窒息早产儿应注意监测凝血指标变化。Objective To study the coagulation function of premature infants at birth and the associated risk factors.Method From January 2014 to January 2018,a prospective study was conducted on preterm infants born in obstetrics department of our hospital.According to the gestational age,these infants are assigned into early preterm group,moderate preterm group and late preterm group.The prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)and thrombin time(TT)were measured using automatic coagulation analyzer.The possible risk factors affecting the coagulation function in each group were analyzed.Result A total of 795 preterm infants were studied including 93 in the early preterm group,151 in the moderate preterm group and 551 in the late preterm group.In the early preterm group,infants with premature rupture of membranes(PROM)had increased FIB,shortened TT,and infants with severe asphyxia had prolonged PT,and the differences were statistically significant(P<0.05).In the moderate preterm group,infants with PROM had significantly prolonged APTT(P<0.05).In the late preterm group,PT and TT were prolonged and FIB was decreased in male infants.Infants with PROM have increased FIB;PT was prolonged among infants with severe asphyxia(P<0.05).Multivariate linear regression analysis showed that neonatal asphyxia,weight and gender were the main factors affecting PT(P<0.05),gestational age was the main risk factor affecting APTT(P<0.05),PROM,gestational age,weight and gender were the main factors affecting FIB(P<0.05),and neonatal asphyxia was the main factor affecting TT(P<0.05).Conclusion The coagulation function of premature infants is affected by many factors including gender,gestational age,weight,asphyxia,PROM,and maternal complications.Coagulation function should be monitored in preterm infants with severe asphyxia.

关 键 词：凝血酶原时间 纤维蛋白原 婴儿 早产 危险因素 

分 类 号：R722[医药卫生—儿科]