新生儿急性呼吸窘迫综合征与凝血纤溶功能的相关性分析  

Correlation between neonatal acute respiratory distress syndrome and blood coagulation fibrinolytic function

作　　者：李小鸥[1] 刘宏[1] 何兵[1] LI Xiaoou;LIU Hong;HE Bing(Dept.of Pediatrics,Renmin Hospital of Wuhan University(East Campus),Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院(东院)儿科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2024年第4期451-455,共5页Medical Journal of Wuhan University

基　　金：湖北省卫生健康委员会科研项目(编号:WJ2023F021)。

摘　　要：目的:探讨急性呼吸窘迫综合征(ARDS)新生儿凝血功能与疾病发生发展及肺部通气/换气功能的关系。方法:选取2020年6月—2022年6月,武汉大学人民医院新生儿科重症监护病房收治的足月ARDS患儿为病例组,根据氧合指数分为轻、中和重度;另外选择同时期出生的50名诊断为湿肺或者新生儿暂时性低血糖的足月儿为对照组。两组患儿均在入院第1天,病例组再于入院第7天取血,检测C-反应蛋白(CRP)、血小板(PLT)、血氧分压(PaO_(2))、血二氧化碳分压(PaCO_(2))及凝血功能[包括纤维蛋白原(FBG)、D-二聚体(D-D)、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)]。结果:与对照组相比,病例组患儿第1天PLT和FBG降低(P<0.05),PT、APTT、D-D及CRP均显著升高(P<0.05),PaO_(2)下降,PaCO_(2)上升(P<0.05)。不同严重程度的病例组患儿PLT、FBG和PaO_(2)随严重程度增加而降低(P<0.05),PT、APTT、D-D、CRP和PaCO_(2)随严重程度增加逐渐增加(P<0.05),尤以中、重度变化明显(P<0.05)。相关性分析提示PaO_(2)和APTT、PT及D-D呈负相关关系,PaCO_(2)和APTT、PT及D-D呈正相关关系。多因素Logistic回归模型分析显示:APTT、PT、D-D水平增高,新生儿窒息,新生儿败血症均是ARDS的危险因素。结论:凝血/纤溶功能可以作为初步评估新生儿ARDS病情严重程度的有效指标,研究新生儿ARDS的凝血/纤溶功能及其与疾病严重程度的关系,对病情评估和治疗指导应有重要意义。Objective:To explore the correlation between the change of neonatal coagulation function,se-verity of neonatal acute respiratory distress syndrome(ARDS),and pulmonary ventilation/ventilation function.Methods:Full-term ARDS children admitted to the Intensive Care Unit of Renmin Hospital of Wuhan University from June 2020 to June 2022 were selected as the case group,which were divid-ed into mild,moderate,and severe groups according to the oxygenation indexes,and 50 healthy term children born at the same period were selected as the control group.Blood samples were taken on the first day and seventh day of hospitalization.The C-reactive protein(CRP),platelet count(PLT),arte-rial partial pressure of oxygen(PaO_(2)),arterial blood carbon dioxide partial pressure(PaCO_(2)),and co-agulation functions,including fibrinogen(FBG),D-dimer(D-D),prothrombin time(PT),and activat-ed partial thrombin time(APTT)were compared.Results:Compared with those in the control group,PLT and FBG in the case group were decreased(P<0.05);PT,APTT,D-D,and CRP were signif-icantly increased(P<0.05);PaO_(2)was decreased while PaCO_(2)was increased(P<0.05).Further-more,from low to high depending on the severity of disease,PLT,FBG,and PaO_(2)decreased while the PT,APTT,D-D,CRP,and PaCO_(2)increased(P<0.05).Multivariate analysis showed the APTT,PT,and D-D were positively correlated with PaO_(2)and negatively correlated with PaCO_(2).The APTT,PT,and D-D levels,neonatal asphyxia,and neonatal sepsis were risk factors for AR-DS.Conclusion:Blood coagulation function plays an important role in the pathological process of neo-natal ARDS.It can be used for early diagnosis as well as the indicators of severity and prognosis of the disease.

关 键 词：急性呼吸窘迫综合征 凝血功能 动脉氧分压 动脉二氧化碳分压 

分 类 号：R722[医药卫生—儿科]