發(fā)布時(shí)間：2019-05-26 23:23

【摘要】：研究背景:腦室周?chē)?腦室內(nèi)出血(Periventricular-Intraventricular hemorrhage,PVH-IVH)是極低出生體重兒(Very low birth weight infants,VLBWI)常見(jiàn)并發(fā)癥,是導(dǎo)致死亡及神經(jīng)發(fā)育障礙的主要原因。其主要是由VLBWI不成熟的生發(fā)基質(zhì)區(qū)、腦室周?chē)踪|(zhì)血管不完善及腦血管的自主調(diào)節(jié)障礙所導(dǎo)致。但是PVH-IVH是否與VLBWI凝血機(jī)制障礙相關(guān)目前尚無(wú)定論,值得我們進(jìn)一步探究。研究目的:研究VLBWI在生后24小時(shí)內(nèi)凝血功能的特點(diǎn)并分析這些指標(biāo)及相關(guān)因素對(duì)PVH-IVH的影響,并探討其臨床意義。資料和方法:本研究收集了從2016年3月24日至2016年12月24日收入青島大學(xué)附屬醫(yī)院NICU的出生體重小于1500g,胎齡小于32周的新生兒共128例。將患兒按體重分組,分為500-749g、750-999g、1000-1249g、1250-1499g共4組;按照胎齡分組,分為23+1-26w,26+1-29w、29+1-32w共3組。所有的新生兒在生后24小時(shí)內(nèi)抽取靜脈血檢查血凝常規(guī);于生后第3、7天常規(guī)進(jìn)行床旁顱腦超聲檢查,根據(jù)顱腦超聲的結(jié)果篩查出腦室周?chē)?腦室內(nèi)出血30例作為PVH-IVH組,無(wú)腦室內(nèi)出血的98例作為對(duì)照組,統(tǒng)計(jì)圍產(chǎn)期相關(guān)臨床資料、新生兒相關(guān)指標(biāo)及輔助檢查。Speason線性相關(guān)及Spearman等級(jí)相關(guān)分析胎齡組及體重組與凝血指標(biāo)的相關(guān)性,用卡方檢驗(yàn)分析圍產(chǎn)期及新生兒生后相關(guān)臨床指標(biāo)與腦室內(nèi)出血相關(guān)性,而用非參數(shù)曼特尼U檢驗(yàn)統(tǒng)計(jì)學(xué)檢驗(yàn)分析腦室內(nèi)出血的發(fā)生與凝血指標(biāo)及血小板的關(guān)系。結(jié)果:(1)128例極低出生體重兒的胎齡與凝血指標(biāo)APTT水平呈負(fù)相關(guān)(r=-0.28,P0.05);胎齡與凝血指標(biāo)PT水平呈負(fù)相關(guān)(r=-0.31,P0.05);而與凝血指標(biāo)FIB水平無(wú)關(guān)(r=0.06,P0.05)。胎齡與PLT水平呈正相關(guān)(r=0.28,P=0.01)。(2)128例極低出生體重兒的體重與凝血指標(biāo)APTT水平呈負(fù)相關(guān)(ρ=-0.45,P0.05);體重與凝血功能指標(biāo)PT水平呈負(fù)相關(guān)(ρ=-0.23,P0.05);體重與凝血功能指標(biāo)FIB水平呈正相關(guān)(ρ=0.25,P0.05);而與凝血指標(biāo)DD無(wú)關(guān)(ρ=-0.14,P0.05)。體重與PLT水平呈正相關(guān)(ρ=0.28,P0.05)。(3)PVH-IVH組與對(duì)照組相比,PVH-IVH與胎齡、出生體重、胎膜早破、生后5 min Apgar評(píng)分5分、胎兒窘迫病史相關(guān)(P均0.05);與對(duì)照組比較,PVH-IVH組的PLT計(jì)數(shù)較低(P0.05),差異具有統(tǒng)計(jì)學(xué)意義,而兩組相關(guān)凝血指標(biāo)APTT、PT、FIB、DD比較,差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:(1)極低出生體重兒的凝血功能與胎齡和體重有關(guān),胎齡越小,體重越低,凝血功能越低下。(2)許多圍產(chǎn)期及新生兒因素導(dǎo)致了PVH-IVH的發(fā)生,其中小胎齡、低出生體重、胎膜早破、胎兒宮內(nèi)窘迫、生后5 min Apgar評(píng)分5分均與腦室內(nèi)出血相關(guān)。(3)生后第一天的凝血異常與PVH-IVH無(wú)明顯相關(guān)。(4)血小板計(jì)數(shù)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，

本文編號(hào)：2485720