极低出生体重儿凝血功能与脑室周围—脑室内出血相关性的临床研究

发布时间：2019-05-26 23:23

【摘要】：研究背景:脑室周围-脑室内出血(Periventricular-Intraventricular hemorrhage,PVH-IVH)是极低出生体重儿(Very low birth weight infants,VLBWI)常见并发症,是导致死亡及神经发育障碍的主要原因。其主要是由VLBWI不成熟的生发基质区、脑室周围白质血管不完善及脑血管的自主调节障碍所导致。但是PVH-IVH是否与VLBWI凝血机制障碍相关目前尚无定论,值得我们进一步探究。研究目的:研究VLBWI在生后24小时内凝血功能的特点并分析这些指标及相关因素对PVH-IVH的影响,并探讨其临床意义。资料和方法:本研究收集了从2016年3月24日至2016年12月24日收入青岛大学附属医院NICU的出生体重小于1500g,胎龄小于32周的新生儿共128例。将患儿按体重分组,分为500-749g、750-999g、1000-1249g、1250-1499g共4组;按照胎龄分组,分为23+1-26w,26+1-29w、29+1-32w共3组。所有的新生儿在生后24小时内抽取静脉血检查血凝常规;于生后第3、7天常规进行床旁颅脑超声检查,根据颅脑超声的结果筛查出脑室周围-脑室内出血30例作为PVH-IVH组,无脑室内出血的98例作为对照组,统计围产期相关临床资料、新生儿相关指标及辅助检查。Speason线性相关及Spearman等级相关分析胎龄组及体重组与凝血指标的相关性,用卡方检验分析围产期及新生儿生后相关临床指标与脑室内出血相关性,而用非参数曼特尼U检验统计学检验分析脑室内出血的发生与凝血指标及血小板的关系。结果:(1)128例极低出生体重儿的胎龄与凝血指标APTT水平呈负相关(r=-0.28,P0.05);胎龄与凝血指标PT水平呈负相关(r=-0.31,P0.05);而与凝血指标FIB水平无关(r=0.06,P0.05)。胎龄与PLT水平呈正相关(r=0.28,P=0.01)。(2)128例极低出生体重儿的体重与凝血指标APTT水平呈负相关(ρ=-0.45,P0.05);体重与凝血功能指标PT水平呈负相关(ρ=-0.23,P0.05);体重与凝血功能指标FIB水平呈正相关(ρ=0.25,P0.05);而与凝血指标DD无关(ρ=-0.14,P0.05)。体重与PLT水平呈正相关(ρ=0.28,P0.05)。(3)PVH-IVH组与对照组相比,PVH-IVH与胎龄、出生体重、胎膜早破、生后5 min Apgar评分5分、胎儿窘迫病史相关(P均0.05);与对照组比较,PVH-IVH组的PLT计数较低(P0.05),差异具有统计学意义,而两组相关凝血指标APTT、PT、FIB、DD比较,差异无统计学意义。结论:(1)极低出生体重儿的凝血功能与胎龄和体重有关,胎龄越小,体重越低,凝血功能越低下。(2)许多围产期及新生儿因素导致了PVH-IVH的发生,其中小胎龄、低出生体重、胎膜早破、胎儿宫内窘迫、生后5 min Apgar评分5分均与脑室内出血相关。(3)生后第一天的凝血异常与PVH-IVH无明显相关。(4)血小板计数降低是PVH-IVH的高危因素。
[Abstract]:Background: periventricular intraventricular hemorrhage (Periventricular-Intraventricular hemorrhage,PVH-IVH) is a common complications in very low birth weight infants (Very low birth weight infants,VLBWI). It is the main cause of death and neurodevelopmental disorder. It is mainly caused by immature gerogenic matrix area of VLBWI, imperfect white matter vessels around ventricle and disturbance of autonomic regulation of cerebral vessels. However, there is no conclusion whether PVH-IVH is related to VLBWI coagulation mechanism disorder, which is worth further exploring. Objective: to study the characteristics of coagulation function of VLBWI within 24 hours after birth and to analyze the effects of these indexes and related factors on PVH-IVH, and to explore its clinical significance. Materials and methods: a total of 128 neonates with birth weight less than 1500 g and gestational age less than 32 weeks were collected from March 24, 2016 to December 24, 2016 in the affiliated Hospital of Qingdao University. The children were divided into 4 groups according to body weight: 500: 749g, 75099g, 10001249g, 12501499g, and according to gestational age, divided into 23126w, 26129wand 29132w groups, and the children were divided into four groups according to their body weight: 500g 749g, 75099g, 10001249g, 12501499g, 23.1: 26w. 291w, 291g. Venous blood samples were taken from all newborns within 24 hours after birth to examine the blood clotting routine. On the 3rd and 7th day after birth, bedside craniocerebral ultrasound was performed. According to the results of craniocerebral ultrasound, 30 cases of periventricular intraventricular hemorrhage were screened as PVH-IVH group and 98 cases without intraventricular hemorrhage as control group. Speason linear correlation and Spearman grade correlation were used to analyze the correlation between gestational age group and body weight and coagulation index, and chi-square test was used to analyze the correlation between related clinical indexes and intraventricular hemorrhage. The relationship between the occurrence of intraventricular hemorrhage and coagulation indexes and platelets was analyzed by nonparametric Mantney U test. Results: (1) the gestational age of 128 very low birth weight infants was negatively correlated with the level of coagulation index APTT (r 鈮，

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