产后出血中相关凝血功能指标监测的研究

目的:探讨产后出血中相关凝血功能指标监测的意义。方法:对我院近4年住院分娩产妇按产后出血量分组:对照组80例,24h出血量<500ml;第一组129例,出血量500~1000ml;第二组47例,出血量>1000ml。回顾性总结3组产妇在产后1h及产后48h相关凝血指标的动态变化。结果:在产后1h第一组与对照组比较Fg与PLT差异具有显著性(P<0.05),第二组和对照组相比PT、APTT、INR、Fg、PLT差异具有显著性(P<0.05),第二组与第一组比较3P阳性率、FDP及D-二聚体差异均有显著性(P<0.05);产后48h第二组PT、Fg与PLT较对照组相比差异具有显著性(P<0.05),第二组与第一组比较3P阳性率、FDP及D-二聚体差异均具有极显著性(P<0.01)。结论:孕晚期妇女发生产后出血时,其凝血指标易有较大变化,其中Fg和PLT的进行性下降与产后出血的失血量关系密切,而DD对产后出血患者凝血功能变化的监测具有较高的敏感性,上述指标对了解病情并指导治疗有重要意义。

Study of the index of coagulation associated with postpartum hemorrhage

Objective:To investigate the mornitoring significance of coagulant index associated with postpartum hemorrhage..Methods:The coagulant index which was examinated in an hour and 48 hours afiex labour of 80 patients (the control group),129 patients whose blood loss was 500~1 000 ml (the first group) and 47 patients whose blood loss was more than 1 000 ml in 24 hours after labour (the control group) were analyzed retrospectively.Results:In an hour after labour,the level of Fg and PLT were significantly lower in the fast group than those of control group (P<0.05). In the second group,PT,APTT,INR,Fg and PLT were significantly different from that of control group (P<0.05). In 48 hours after labour,the level of PT,Fg and PLT in the second group were significantly different from that of control group (P<0.05). 3P,FDP and D-dimer of the second group were higher than those of the fast group (P<0.01).Conclusion:The coagulant index is apt to change greatly associated with postpartum hemorrhage. The decreased levels of Fg and PLT are obviously related with the amount of blood loss and D-dimer is sensitive to monitor the variety of coagulation function.