低分子量肝素联合新鲜冰冻血浆在危重新生儿凝血功能异常中的应用

陈茹茹; 罗厚江; 杨军; 贾文婷; 王磊; 郭宏慧

doi:10.16766/j.cnki.issn.1674-4152.001873

低分子量肝素联合新鲜冰冻血浆在危重新生儿凝血功能异常中的应用

doi: 10.16766/j.cnki.issn.1674-4152.001873

1.
蚌埠医学院第二附属医院儿科，安徽蚌埠 233000
2.
蚌埠医学院第一附属医院儿科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究重点项目 KJ2019A0342

蚌埠医学院自然科学重点项目 BYKY2019158ZD

蚌埠医学院自然科学重点项目 BYKY2019155ZD

详细信息

通讯作者:
罗厚江, E-mail: 94012167@qq.com

中图分类号: R722.15
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出版历程
- 收稿日期: 2020-08-13
- 网络出版日期: 2022-02-16

Application of low molecular weight heparin combined with fresh frozen plasma in the treatment of coagulation abnormalities in critically ill neonates

1.
Department of Paediatrics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨低分子量肝素联合新鲜冰冻血浆在危重新生儿凝血功能异常中应用的临床效果。方法选取蚌埠医学院第二附属医院新生儿病房2019年2月—2020年8月收治的危重凝血功能异常患儿72例，采用随机数字表法分为观察组(35例)，对照组(37例)。所有患儿入院后6 h内检测凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体(D-D)及血小板(PLT)水平。对照组进行针对原发病的常规治疗，观察组在常规治疗的基础上加用低分子量肝素与新鲜冰冻血浆，治疗72 h后复测上述指标。比较2组患儿的临床疗效、凝血功能指标及并发症发生率。结果治疗后，观察组总有效率高于对照组，差异有统计学意义(P < 0.05);2组治疗前PT、APTT、FIB、TT、D-D和PLT水平差异无统计学意义(均P>0.05);治疗后观察组PT、APTT、TT及D-D水平均低于对照组，且FIB水平高于对照组，差异有统计学意义(均P < 0.05);治疗后2组PLT水平比较差异无统计学意义(P>0.05)。治疗后2组PT、APTT、TT和D-D水平均低于治疗前，且FIB水平高于治疗前(均P < 0.05);治疗后2组PLT水平高于治疗前(均P < 0.05);治疗后2组颅内出血、消化道出血及肺出血等并发症发生率比较差异无统计学意义(均P>0.05)。结论低分子量肝素联合新鲜冰冻血浆在危重新生儿凝血功能异常中的早期干预可以改善临床症状，使凝血功能尽早恢复，具有较好的临床效果。
- 低分子量肝素 /
- 新鲜冰冻血浆 /
- 凝血功能 /
- 应用
Abstract: Objective To investigate the clinical effects of low molecular weight heparin combined with fresh frozen plasma in the treatment of abnormal coagulation functions in critically ill neonates. Methods Seventy-two critically ill children with coagulopathy admitted to the neonatal ward of The Second Affiliated Hospital of Bengbu Medical College from February 2019 to August 2020 were selected and divided into an observation group (n=35) and a control group (n=37). Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-Dimer (D-D) and platelet (PLT) levels were monitored. The control group received conventional treatment, whereas the observation group was administered with low molecular weight heparin and fresh frozen plasma on the basis of conventional treatment. The aforementioned indicators were retested after 72 h of treatment. The clinical efficacy, coagulation function indexes and complication incidence of the two groups were compared. Results The effective rate of the observation group was significantly higher than that of the control group after treatment (P < 0.05). No significant difference was observed in the levels of PT, APTT, FIB, TT, D-D and PLT between the two groups before treatment (all P>0.05). After treatment, the PT, APTT, TT and D-D levels of the observation group were significantly lower than those of the control group (all P < 0.05). By contrast, the FIB level of the observation group was significantly higher than that of the control group (P < 0.05). After treatment, the PLT level of the observation group was lower than that of the control group, but the difference was not statistically significant (P>0.05). After treatment, the levels of PT, APTT, TT and D-D in both groups were significantly lower than those before the treatment (all P < 0.05). Furthermore, the level of FIB was significantly higher than that before the treatment (P < 0.05). The levels of PLT in both groups after the treatment were significantly higher than those before thetreatment (P < 0.05). After the treatment, the incidence of intracranial haemorrhage, gastrointestinal hemorrhage and pulmonary hemorrhage in the observation group was lower than that in the control group, but the difference was not statistically significant (all P>0.05). Conclusion Early intervention with low molecular weight heparin combined with fresh frozen plasma in the treatment of abnormal coagulation functions in critically ill newborns can improve clinical symptoms and restore coagulation functions. This intervention has good clinical effects.
- Low molecular weight heparin /
- Fresh frozen plasma /
- Coagulation function /
- Application

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表 1 2组凝血功能异常危重患儿一般资料比较(例)

组别	例数	性别		顺产/剖宫产	窒息	胎膜早破	脐带绕颈	危重症评分(x±s，分)	胎龄(x±s，周)	出生体重(x±s，g)
组别	例数	男	女		窒息	胎膜早破	脐带绕颈	危重症评分(x±s，分)	胎龄(x±s，周)	出生体重(x±s，g)
观察组	35	20	15	19/16	15	8	5	84.80±3.08	36.61±1.50	2 795.57±288.48
对照组	37	18	19	18/19	11	13	7	85.24±3.37	36.47±1.57	2 809.59±281.60
统计量		0.521^a		0.226^a	1.343^a	1.312^a	0.278^a	0.581^b	0.367^b	0.209^b
P值		0.471		0.635	0.246	0.252	0.258	0.563	0.715	0.835
注：^a为χ²值，^b为t值。

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表 2 2组凝血功能异常危重患儿治疗72 h后总有效率比较[例(%)]

组别	例数	显效	有效	无效	总有效率(%)
观察组	35	16(45.71)	16(45.71)	3(8.57)	91.43
对照组	37	13(35.14)	14(37.84)	10(27.02)	72.97
注：2组总有效率比较，χ²=4.141，P=0.042。

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表 3 2组凝血功能异常危重患儿治疗前、后凝血功能及血小板水平比较(x±s)

组别	例数		PT(s)	APTT(s)	FIB(g/L)	TT(s)	D-D(mg/L)	PLT(×10⁹/L)
观察组	35	治疗前	16.98±1.74	69.51±9.23	1.08±0.12	22.19±2.71	2.13±0.81	182.54±25.21
		治疗后	12.76±1.22^a	44.13±6.23^a	2.24±0.42^a	15.69±1.80^a	0.90±0.50^a	215.69±50.52
t值			5.161	5.111	5.144	14.970	5.111	3.989
P值			< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
对照组	37	治疗前	16.74±1.91	69.70±8.39	1.09±0.10	22.17±2.61	2.20±0.92	182.51±24.80
		治疗后	13.92±1.48	58.44±16.58	2.04±0.36	17.89±4.27	1.28±0.78	238.41±66.63
t值			4.433	3.407	5.160	5.008	4.783	4.464
P值			< 0.001	0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：与同期对照组比较，^aP < 0.05。

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表 4 2组凝血功能异常危重患儿治疗后出血并发症发生率比较[例(%)]

组别	例数	颅内出血	消化道出血	肺出血	出血并发症总发生率(%)
观察组	35	1(2.86)	1(2.86)	1(2.86)	8.57
对照组	37	2(5.41)	5(13.51)	2(5.41)	24.32
注：2组出血并发症总发生率比较，χ²=3.214，P=0.073。

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参考文献(23)

[1]	罗素云. APTT、PT、FIB与D-D水平在新生儿早期凝血功能障碍中的诊断价值分析[J]. 中国实用医药, 2019, 14(16): 69-70. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201916036.htm
[2]	何成龙, 罗素云, 廖文森. 危重新生儿凝血功能指标与危重评分的相关性[J]. 实用临床医学, 2019, 20(1): 55-56. https://www.cnki.com.cn/Article/CJFDTOTAL-LCSY201901021.htm
[3]	PADUNGMANEESUB W, REUNGRONGRAT S, MANOWONG S, et al. Biomarkers of disseminated intravascular coagulation in pediatric intensive care unit in Thailand[J]. Int J Lab Hematol, 2019, 41(1): 32-38. doi: 10.1111/ijlh.12917
[4]	郑佳能. 低分子肝素治疗弥散性血管内凝血产妇的效果及安全性[J]. 中国妇幼保健, 2018, 33(3): 542-544. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201803021.htm
[5]	杨婷, 高清平. 4个积分系统在弥散性血管内凝血诊断与预后评估中的作用[J]. 临床血液学杂志, 2017, 30(3): 358-363. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201705029.htm
[6]	VANVOOREN D M, BRADSHAW W T, BLAKE S M. Disseminated intravascular coagulation in the neonate[J]. Neonatal Netw, 2018, 37(4): 205-211. doi: 10.1891/0730-0832.37.4.205
[7]	邵晓梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2018: 801-805.
[8]	刘国辉, 冯永瑜, 黄书炜. 凝血功能在新生儿黄疸中的临床意义分析[J]. 中国实用医药, 2020, 15(18): 79-80. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202018035.htm
[9]	罗敏, 宗莹, 吴李萍, 等. TEG指导新生儿凝血功能障碍诊治过程中的临床研究[J]. 国际检验医学杂志, 2020, 41(11): 1362-1365, 1370. doi: 10.3969/j.issn.1673-4130.2020.11.019
[10]	WEISS S L, PETERS M J, ALHAZZANI W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children[J]. Intensive Care Med, 2020, 46(Suppl 1): 10-67. http://journals.lww.com/pccmjournal/Fulltext/2020/02000/Surviving_Sepsis_Campaign_International_Guidelines.20.aspx
[11]	IBA T, UMEMURA Y, WATANABE E, et al. Diagnosis of sepsis-induced disseminated intravascular coagulation and coagulopathy[J]. Acute Med Surg, 2019, 6(3): 223-232.
[12]	SUZULI K, WADA H, IMAI H, et al. A re-evaluation of the D-dimer cut-off value for making a diagnosis according to the ISTH overt-DIC diagnostic criteria: communication from the SSC of the ISTH[J]. J Thromb Haemost, 2018, 16(7): 1442-1444. doi: 10.1111/jth.14134
[13]	金彦, 朱敏, 牛艳昕, 等. 低分子肝素联合硫酸镁治疗胎儿生长受限的效果及对围生儿结局的影响[J]. 中华全科医学, 2018, 16(10): 1677-1679. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201810027.htm
[14]	方颖, 杜鹃. 低分子肝素治疗胎儿宫内生长受限效果及对胎盘电镜结构与FPR2表达的影响[J]. 中国临床研究, 2020, 33(8): 1037-1040. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202008007.htm
[15]	MAZARICO E, PEGUERO A, CAMPRUBIÍ M, et al. Study protocol for a randomised controlled trial: treatment of early intrauterine growth restriction with low molecular weight heparin (TRACIP)[J]. BMJ Open, 2018, 8(10): e020501. doi: 10.1136/bmjopen-2017-020501
[16]	FAN Y, JIANG M, GONG D, et al. Efficacy and safety of low-molecular-weight heparin in patients with sepsis: a meta-analysis of randomized controlled trials[J]. Sci Rep, 2016, 6: 25984. doi: 10.1038/srep25984
[17]	周锦龙, 罗昊, 胡向文, 等. 低分子肝素抗凝治疗对肺出血新生儿凝血功能指标的影响[J]. 中国当代医药, 2018, 25(31): 140-143. doi: 10.3969/j.issn.1674-4721.2018.31.045
[18]	BIANCHI P, COTZA M, BECCARIS C, et al. Early or late fresh frozen plasma administration in newborns and small infants undergoing cardiac surgery: the APPEAR randomized trial[J]. Br J Anaesth, 2017, 118(5): 788-796. doi: 10.1093/bja/aex069
[19]	WANG T, WANG X, LIU J, et al. Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery[J]. Paediatr Anaesth, 2018, 28(10): 914-923. doi: 10.1111/pan.13473
[20]	RODGER M A, GRIS J C, DE VRIES J, et al. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials[J]. Lancet, 2016, 388(10060): 2629-2641. doi: 10.1016/S0140-6736(16)31139-4
[21]	LEVI M, SCULLY M. How I treat disseminated intravascular coagulation[J]. Blood, 2018, 131(8): 845-854. doi: 10.1182/blood-2017-10-804096
[22]	马其辉. 低分子肝素治疗溃疡性结肠炎高凝状态的疗效观察[J]. 中国基层医药, 2018, 25(2): 141-144. doi: 10.3760/cma.j.issn.1008-6706.2018.02.002
[23]	张春峰, 贺艺璇, 吴润辉, 等. 低分子肝素辅助治疗D-二聚体升高的儿童重症肺炎支原体肺炎的疗效观察[J]. 北京医学, 2019, 41(3): 183-186. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX201903004.htm