新生儿窒息的凝血功能及抗凝血酶Ⅲ VWF D-二聚体测定及其临床意义

目的:探讨新生儿窒息患者的凝血功能和抗凝血酶Ⅲ、VWF、D-D的变化及其意义。方法:采用酶联荧光分析法和发色底物法分别测定42例不同程度窒息新生儿和16例正常新生儿VWF及D-D的含量及AT-Ⅲ的活性,同时检测INT、TT、APTT、Fbg及BPC的变化。结果:重度窒息组的AT-Ⅲ明显降低,窒息新生儿血浆的VWF、D-D平均值均有不同程度增高,重度窒息组升高更为显著,与正常对照组比较,其差异具有显著性意义(P<0.05,P<0.01)。窒息后并发器官功能损害新生儿与无并发症组比较,血浆的VWF、D-D均有不同程度的升高,以脑损害组升高最为明显(P<0.05,P<0.01)。结论:窒息新生儿表现以高凝状态为主的早期D IC,VWF及D-D的升高与窒息的程度有关,VWF及D-D明显升高者常合并组织器官损害。测定窒息新生儿血浆中AT-Ⅲ、VWF、D-D等指标对窒息后新生儿临床选用抗凝药物治疗及疗效观察、预后判断,均有一定的指导意义。

Detection and clinical significance of coagulation function, serum AT -Ⅲ, VWF,D- D in newborns with asphyxia

Objective:To explore the changes and clinical significance of serum AT-Ⅲ,VWF,and D-D in newborns with asphyxia.Methods:To detect 3 indices of AT-Ⅲ,VWF,D-D,the level of BPC,INT,Fbg in 42 asphyxiated newborns and 16 healthy controls.All subjects were divided into mild asphyxia group,severe asphyxia group and control group.Results:Compared with control group,the level of AT-Ⅲ decreased significantly in severe asphyxia group.The level of VWF,D-D increased in asphyxia infants especially in severe group.The level of serum VWF,D-D increased significantly in the asphyxiated infants with complications especially the infants with brain damage.Conclusion:The early DIC characterized by hyper coagulation is present in asphyxiated infants.The level of serum VWF and D-D is related with the degree of asphyxia and organ dysfunction.The assessment of AT-Ⅲ,VWF and D-D will play an important role in the choice of anti-coagulation treatment,the evaluation of the patient's condition and prognosis.