足月儿出生时脐血凝血状态的研究

目的 探讨正常足月儿出生时脐带血的凝血功能,评价各项指标的波动范围,为临床评估足月儿凝血功能提供参考范围,给干预治疗提供依据.方法 2014年1月至2015年12月前瞻性调查52对母儿,根据影响因素分为高龄产妇组、适龄产妇组,围生期感染组、非感染组,妊娠合并症组、健康孕妇组,再分别进行比较,通过非肝素化的脐带静脉及动脉标本,检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT).结果 足月儿脐动脉血各凝血指标PT、APTT、FIB、TT值分别为11.5~17.4s、45.2~93.6s、0.8~2.1g/L、18.6~28.3s,脐静脉血分别为11.0~15.3s、46.2~81.9s、0.9~2.0g/L、19.1~27.4s,比较差异均无统计学意义,t值分别为1.605、0.366、1.399、0.150,均P>0.05;足月儿脐静脉血PT、APTT、TT明显高于产妇静脉血,FIB低于产妇静脉血,差异均有统计学意义,t值分别为16.060、16.588、3.601、24.234,均P<0.05;PT在围产期感染组为11.3±1.7s,短于非感染组,差异有统计学意义(t=3.071,P<0.05);FIB在妊娠合并症组为1.0±0.2g/L,低于健康孕妇组,差异有统计学意义(t=3.123,P<0.05);早产儿PT、APTT、TT明显高于足月儿,FIB低于足月儿,差异均有统计学意义,t值分别为5.616、7.375、2.227、2.541,均P<0.05.结论 足月新生儿出生时脐动静脉血凝血指标无明显差别,PT、APTT、TT值较早产儿低,脐静脉血PT、APTT、TT明显高于产妇静脉血各指标,围生期感染时脐血PT缩短,妊娠合并疾病时脐血FIB降低,这些指标的初步研究结果,可为临床研究和应用提供参考,值得进一步研究.

Umbilical cord blood coagulation state of full-term infants at birth

Objective To investigate umbilical cord blood coagulation function of normal full-term infants at birth for determining the range of values for each index and providing reference range for clinical evaluation of coagulation in full -term infants, so as to provide basis for intervention therapy .Methods From January 2014 to December 2015, 52 mother-child pairs were prospectively studied and divided into different groups based on influencing factors , advanced maternal age group , normal gestational age group , perinatal infection group , non-infection group , complicated pregnancy group , and healthy pregnancy group .Different groups were compared respectively .Prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , fibrinogen ( FIB) , and thrombin time ( TT) were measured in non-heparinized umbilical cord venous and arterial blood samples .Results Values of PT, APTT, FIB and TT of umbilical arterial blood of full-term infants ranged 11.5 to 17.4s, 45.2 to 93.6s, 0.8 to 2.1g/L and 18.6 to 28.3s, respectively, and those of umbilical venous blood ranged 11.0 to 15.3s, 46.2 to 81.9s, 0.9 to 2.0g/L and 19.1 to 27.4s, respectively.Differences between umbilical arterial and venous blood values were not statistically significant (t value was 1.605, 0.366, 1.399 and 0.150, respectively, all P>0.05).PT, APTT and TT values of umbilical venous blood of full-term infants were significantly longer than those of maternal venous blood , but FIB level was lower with statistically significant difference (t value was 16.060, 16.588, 3.601 and 24.234, respectively, all P<0.05).PT in perinatal infection group was 11.3 ±1.7s, which was shorter than that in non-infection group and the difference was significant (t=3.071,P<0.05).FIB level in complicated pregnancy group was 1.0 ±0.2g/L, which was lower than that in healthy pregnancy group , and the difference was statistically significant (t=3.123, P<0.05).PT, APTT and TT values of premature infants were significantly longer than those of full-term infants but FIB level was lower, and the differences were significant (t value was 5.616, 7.375, 2.227 and 2.541, respectively, all P<0.05).Conclusion There are no significant differences between umbilical cord arterial and venous blood coagulation indices in full -term infants at birth, but PT, APTT and TT values are lower than those of premature infants .PT, APTT and TT values of umbilical venous blood are significantly longer than those of maternal venous blood .During perinatal infection , PT of umbilical blood is shortened , and FIB of umbilical blood is decreased in mothers with pregnancy complications .The preliminary results of this study can provide a reference for clinical study and application , and further study is worthwhile .