早产儿凝血功能异常的危险因素分析及其与新生儿危重病例评分的相关性  

Risk factors of coagulation disorders in premature infants and its correlation with neonatal critical illness scores

作　　者：李康裕 史惠 陈日玲 LI Kang-yu;SHI Hui;CHEN Ri-ling(Grade 2019,Guangdong Medical University,Zhanjiang,Guangdong 524000,China;Department of Pediatrics,Dongguan Children’s Hospital,Dongguan,Guangdong 523320,China;Department of Pediatrics,Shunde Women and Children’s Hospital Affiliated to Guangdong Medical University,Foshan,Guangdong 528300,China)

机构地区：[1]广东医科大学,广东湛江524000 [2]东莞市儿童医院儿科,广东东莞523320 [3]广东医科大学附属顺德妇女儿童医院儿科,广东佛山528300

出　　处：《中华实用诊断与治疗杂志》2021年第8期834-837,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：广东省基础与应用基础研究基金自然科学基金(2020A1515010240)。

摘　　要：目的探讨新生儿危重病例评分与凝血功能异常的相关性及早产儿凝血功能异常的危险因素。方法582例早产儿,均行活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血浆纤维蛋白原(fibrinogen,FIB)、凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)检测,并根据凝血功能是否正常分为正常组146例和异常组436例,记录并比较2组一般资料和出血发生率;采用多因素logistic回归分析早产儿发生凝血功能异常的影响因素。采用新生儿危重病例评分(neonatal critical illness scores,NCIS)进行疾病严重程度评估,根据疾病严重程度分为非危重组225例,危重组228例,极危重组129例,比较3组APTT、FIB、PT和TT,采用Spearman相关性分析患儿凝血指标与病情严重程度的相关性。结果正常组顺产比率(56.85%)高于异常组(45.41%)(P<0.05),小于胎龄儿(14.38%)、胎膜早破(13.70%)比率和出血发生率(14.38%)均低于异常组(23.62%、21.33%、22.71%)(P<0.05)。胎膜早破(OR=1.823,95%CI:1.068~3.111,P=0.028)、出生窒息(OR=1.726,95%CI:1.042~2.860,P=0.034)是早产儿凝血功能异常的独立危险因素。非危重组、危重组、极危重组APTT[(65.63±19.05)、(70.35±19.99)、(77.65±24.67)s]、PT[(15.19±5.33)、(15.45±6.22)、(16.89±5.20)s]依次延长(P<0.05),3组FIB、TT比较差异均无统计学意义(P>0.05)。APTT、PT与早产儿病情严重程度呈正相关(r=0.198,P<0.001;r=0.161,P<0.001)。结论胎膜早破、出生窒息是早产儿凝血功能异常发生的独立危险因素;APTT、PT与早产儿病情危重程度相关,危重早产儿更易发生凝血功能异常。Objective To investigate the correlation between neonatal critical illness scores and coagulation disorder and to analyze the risk factors of coagulation disorder in premature infants.Methods The activated partial thromboplastin time(APTT),fibrinogen(FIB),prothrombin time(PT)and thrombin time(TT)were determined in 582 premature infants.According to the coagulation function,582 premature infants were divided into normal group(n=146)and abnormal group(n=436).The clinical data and hemorrhage incidence were recorded and compared between two groups.Multivariate logistic regression analysis was used to evaluate the influencing factors of coagulation disorder in premature infants.According to the neonatal critical illness scores(NCIS),the infants were divided into non-critical group(n=225),critical group(n=228)and extremely-critical group(n=129).The APTT,FIB,PT and TT were compared among three groups.Spearman correlation analysis was used to assess the correlation between the coagulation indexes and the severity of disease.Results The rate of natural birth was higher in normal group(56.85%)than that in abnormal group(45.41%)(P<0.05).The percentages of small for gestational age infants and premature rupture of membrane as well as the incidence of hemorrhage were lower in normal group(14.38%,13.70%,14.38%))than those in abnormal group(23.62%,21.33%,22.71%)(P<0.05).Premature rupture of membrane(OR=1.823,95%CI:1.068-3.111,P=0.028)and birth asphoxia(OR=1.726,95%CI:1.042-2.860,P=0.034)were the independent risk factors of coagulation disoder in premature infants.APTT((65.63±19.05),(70.35±19.99),(77.65±24.67)s)and PT((15.19±5.33),(15.45±6.22),(16.89±5.20)s)prolonged gradually in turn in non-critical group,critical group and extremely-critical group(P<0.05).There were no significant differences in FIB and TT among three groups(P>0.05).APTT and PT were positively correlated with the severity of disease in premature infants(r=0.198,P<0.001;r=0.161,P<0.001).Conclusion Premature rupture of membrane and birth asphyxia are the i

关 键 词：凝血功能异常 早产儿 危险因素 新生儿危重病例评分 相关性 

分 类 号：R722.6[医药卫生—儿科]