产妇分娩前检测凝血四项、D-二聚体及血小板的临床分析

目的:研究产妇分娩前检测凝血四项、D-二聚体及血小板水平及临床意义,为临床诊疗提供指导依据。方法:回顾性分析2017年1月至2019年12月在江汉大学附属医院(武汉市第六医院)建立围产期保健手册的1200例产妇作为研究对象。根据产妇产后出血情况,将所有产妇分为研究组(产后出血)与对照组(正常分娩),其中研究组产妇共420例,对照组产妇共780例。对1200例孕妇的就诊资料中的凝血四项纤维蛋白原(fibrinogen,FIB)、凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)]、D-二聚体水平及血小板计数水平的检测结果进行收集。比较分析产妇孕早期、中期、晚期以及临产前不同时期凝血四项与D-二聚体的检测结果。结果:孕期产妇D-二聚体水平逐渐升高,差异有统计学意义(P<0.05);孕早期、孕中期与孕晚期PT水平比较,差异有统计学意义(P<0.05);4个时期的TT比较,差异无统计学意义(P>0.05);早期产妇的APTT明显长于中期、晚期与临产前,差异有统计学意义(P<0.05);孕早期、中期、晚期以及临产前产妇FIB水平逐渐升高,差异有统计学意义(P<0.05);研究组产妇PT与APTT明显低于对照组产妇,差异有统计学意义(P<0.05);研究组产妇FIB水平明显高于对照组产妇,差异有统计学意义(P<0.05);研究组产妇TT与对照组产妇相比,差异无统计学意义(P>0.05);研究组产妇血小板计数水平明显低于对照组产妇,差异有统计学意义(P<0.05);研究组D-二聚体水平明显高于对照组,差异有统计学意义(P<0.05)。结论:对产妇分娩前进行凝血四项、D-二聚体及血小板水平的检测,能够对凝血功能异常情况进行及时纠正,对产后出血与血栓的预治有较为重要的指导意义。

Clinical analysis for four items of coagulation,D-dimer,and platelet in puerperae before delivery

Objective:To study the levels and clinical significance of four items of coagulation,D-dimer,and platelet before delivery,and provide guidance for clinical diagnosis and treatment.Methods:The retrospective analysis was used to research 1200 puerperae eastablishing a manual for perinatal health care in Affiliated Hospital of Jianghan University(Wuhan Sixth Hospital)from January 2017 to December 2019.According to postpartum hemorrhage,all puerperae were divided into a study group(postpartum hemorrhage)and a control group(normal delivery).There were 420 cases in the study group and 780 cases in the control group.We collected the test results of four coagulation itemsfibrinogen(FIB),prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT)],D-dimer and platelet count in 1200 pregnant women.And then,we also compared with and analyzed the test results of coagulation and D-dimer in early,middle,late pregnancy and diverse periods before labor.Results:D-dimer in pregnant women increased gradually,and the difference was statistically significant(P<0.05).The difference was not statistically significant in comparing the PT of late pregnancy with the early and middle pregnancy(P<0.05).The difference was not statistically significant in comparing the TT of four preiods(P>0.05).The APTT of early pregnancy was significantly longer than that in the middle,late pregnancy and before labor and the difference is statistically significant(P<0.05).The FIB of puerperae in the early,middle,late pregnancy and pre parturient increased gradually,and the difference was statistically significant(P<0.05).With the statistic significance of the differences,the PT and APTT in the study group were obviously lower than that of the control group(P<0.05),but its FIB was more than the control group(P<0.05).The difference of TT between the study group and the control group was statistically significant(P>0.05).The platelet count of the study group was much less than that of control gtoup,while its D-dimer was more than the control group,and the differences were statistically significant(P<0.05).Conclusion:The detection of four items of blood coagulation,D-dimer and platelet before delivery can facilitate the management of the abnormal blood coagulation in time,which is a very significant guidance for the pre-treatment of postpartum hemorrhage and thrombus.