新生儿出生后24小时内凝血功能检测的临床意义分析

目的探讨不同胎龄以及不同体重新生儿凝血功能指标的差异,为判断凝血功能指标的临床意义提供参考。方法2015年1月至2018年12月期间,在解放军总医院第五医学中心新生儿科住院治疗的新生儿中,纳入170例胎龄28~42周、出生8 h内入院的新生儿,其中男性87例,女性83例。按胎龄分为早期早产儿组、晚期早产儿组和足月儿组。按新生儿出生体重分为正常出生体重组、低出生体重组和极低出生体重组。按是否小于胎龄分为早产适于胎龄儿组、早产小于胎龄儿组、足月适于胎龄儿组、足月小于胎龄儿组。于生后24 h内抽取静脉血,检测活化部分凝血活酶时间(activatedpartial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin,TT)及D-二聚体(D-dimer)。结果早期早产儿组的APTT、PT、D-二聚体水平均高于晚期早产儿组及足月儿组(P值均<0.05),FIB水平低于晚期早产儿组及足月儿组(P值均<0.05);晚期早产儿组的APTT、PT水平均高于足月儿组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。极低出生体重组的APTT、PT、D-二聚体水平均高于低出生体重组及正常出生体重组(P值均<0.05),FIB水平低于低出生体重组及正常出生体重组(P值均<0.05);低出生体重组的APTT、PT水平均高于正常出生体重组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。早产小于胎龄儿组D-二聚体水平高于早产适于胎龄儿组(P<0.05),其余指标比较差异无统计学意义(P值均>0.05);足月适于胎龄儿与足月小于胎龄儿组的凝血指标比较,差异均无统计学意义(P值均>0.05)。早产儿出血发生率高于足月儿[26.6%(29/109)与8.2%(5/61),χ^2=9.019,P=0.003]。结论新生儿凝血指标有胎龄和体重差异,胎龄越小、体重越低的新生儿凝血功能越不完善。

Clinical significance of testing blood coagulation function in newborns within 24 hours after birth

Objective To compare the components of coagulation fibrinolytic system in newborns of different gestational age and different weight, and to provide reference for the clinical significance of coagulation function index. Methods One hundred and seventy cases of newborns(gestational age 28-42 weeks, within 8 h after birth, 87 males, 83 females) hospitalized in The Fifth Medical Center of PLA General Hospital from January 2015 to December 2018 were divided into three groups according to gestational age: early preterm neonates group(28-33+6 weeks), late preterm neonates group(34-36+6 weeks), full-term neonates group(37-42 weeks). According to birth weight, they were divided into normal weight group(2 500 g ≤ birth weight<4 000 g), low birth weight group(1 500 g ≤ birth weight<2 500 g), and very low birth weight group(<1 500 g). According to the gestational age, they were divided into preterm infants suitable for gestational age group, preterm infants small for gestational age group, term infants suitable for gestational age group and term infants small for gestational age group. The activated partial thromboplastin time(APTT), prothrombin time(PT), thrombin time(TT), the level of fibrinogen(FIB) and D-dimer in neonates were detected within 24 h after birth. Results The level of APTT, PT and D-dimer in early preterm neonate group was higher than that in the late preterm neonates group and fullterm neonates group(all P<0.05), and the level of FIB in early preterm neonate group was lower than that in the late preterm neonates group and full-term neonates group(all P<0.05). The level of APTT, PT in the late preterm neonates group was higher than that in the full-term neonates group(all P<0.05), but there were no significant differences in the level of D-dimer and FIB between the two groups(P>0.05). The level of APTT, PT and D-dimer in very low birth weight group was higher than that in low birth weight group and normal weight group(all P<0.05), and the level of FIB in very low birth weight group was lower than that in the low birth weight group and normal weight group(all P<0.05). The level of APTT, PT in low birth weight group was higher than that in normal weight group(all P<0.05), but there were no significant differences in D-dimer and FIB between the two groups(all P>0.05). The level of D-dimer in preterm infants small for gestational age group was higher than that in preterm infants suitable for gestational age group(P<0.05), and there were no significant differences about other coagulation indexes(all P>0.05). There were no significant differences in blood coagulation indexes between term infants suitable for gestational age group and term infants small for gestational age group(P>0.05). The incidence of bleeding in premature infants was higher than that in term infants [26.6%(29/109) vs 8.2%(5/61), χ^2=9.019, P=0.003]. Conclusions The coagulation indexes of neonates showed difference in different gestational age and birth weight. The smaller for gestational age and the lower for birth weight, the more imperfect the coagulation function is.