早产儿脑室周围-脑室内出血凝血功能的变化

摘要

目的：探讨早产儿脑室周围-脑室内出血（PVH-IVH）对机体凝血功能的变化，影响因素及评估预后。方法纳入PVH-IVH早产儿46例作为观察组，同时纳入非PVH-IVH早产儿45例作为对照组。分别观察两组患儿凝血酶原时间（PT）、部分凝血酶原时间（APTT）、纤维蛋白原（FiB）、D二聚体（DD）等凝血功能指标的差异；采用单因素分析以及多因素Logistic分析导致PVH-IVH发生的危险因素；采用行为神经评分（NBNA）对两组患儿的预后进行评估。结果观察组APTT、DD水平分别为（60.30±13.09）s、（2.02±1.19）mg/L，对照组分别为（54.51±9.84）s、（1.25±0.81）mg/L，差异有统计学意义（P<0.05）；单因素分析显示：胎龄、新生儿呼吸窘迫综合征、高体积分数氧、肺动脉高压、机械通气等均是影响PVH-IVH的危险因素（P<0.05）。多因素Logistic分析显示：胎龄（<30周）、新生儿呼吸窘迫综合征、高体积分数氧、机械通气等均是导致PVH-IVH发生的独立危险因素（P<0.05）；纠正胎龄至40周，观察组平均NBNA评分为（34.26±3.10）分，对照组平均NBNA评分为（36.53±2.34）分，差异有统计学意义（P<0.05）。结论早产儿PVH-IVH能够导致机体凝血功能的异常，而胎龄、新生儿呼吸窘迫综合征、高体积分数氧以及机械通气则是造成PVH-IVH发生的高危因素。通过预防危险因素，早期治疗凝血功能异常的早产儿，能够避免PVH-IVH的发生。%ObjectiveTo study the changes,influence factor and prognosis evaluation of PVH-IVH in the coagulation function for premature infant.Methods46 premature infants with PVH-IVH were selected as study group. 45 premature infants without PVH-IVH were selected as control group. The coagulation function index of PT,APTT,FiB and D-D for two groups was observed. The signle factor analysis and multi-factor Logistic analysis was used to investigate the risk factors of PVH-IVH;NBNA was used to evaluate the infant's prognosis.Result The level of APTT and D-D for study group was(60.30±13.09)s and(2.02±1.19)mg/L;the level for control group was(54.51±9.84)s and(1.25±0.81)mg/L (P<0.05);according to single factor analysis,the risk factors of PVH-IVH included gestational age,neonatal respiratory distress syndrome, hyperoxia,pulmonary hypertension,mechanical ventilation,etc(P<0.05);according to multi-factor Logistic analysis,the independent risk factor of PVH-IVH included gestational age(<30w),neonatal respiratory distress syndrome,hyperoxia,mechanical ventilation,etc(P<0.05);based on the gestational age(40w),NBNA point for study group was(34.26±3.10)and the point for control group was(36.53±2.34)(P<0.05). ConclusionsPVH-IVH will cause the abnormity of the premature infant's coagulation function. The high risk factors of PVH-IVH include gestational age,neonatal respiratory distress syndrome,hyperoxia and mechanical ventilation. The prevention of risk factors and early treatment of abnormal coagulation function can prevent the incidence of PVH-IVH.