1 057例新生儿出生初期部分凝血功能检测指标危急值分析

张梦梦; 汤慧丽; 黄河; 蔡敬星; 吴小颖; 杨传忠; 余章斌; 李思涛; 周晓光

doi:10.16766/j.cnki.issn.1674-4152.002883

1 057例新生儿出生初期部分凝血功能检测指标危急值分析

doi: 10.16766/j.cnki.issn.1674-4152.002883

1.
中山大学附属第八医院新生儿科，广东深圳 518000
2.
深圳市妇幼保健院新生儿科，广东深圳 518000
3.
深圳市人民医院新生儿科，广东深圳 518000
4.
中山大学附属第六医院新生儿科, 广东广州 510655

基金项目:

广州市科技计划项目 202002030008

国家自然科学基金项目 81741086

详细信息

通讯作者:
周晓光，E-mail: gzzhouxg@163.com

中图分类号: R722.1 R446
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- 被引次数: 0
出版历程
- 收稿日期: 2023-01-09
- 网络出版日期: 2023-04-19

Analysis of the critical values of partial coagulation function indicators in 1 057 neonates in the early stages of life

1.
Department of Neonatology, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518000, China

摘要

摘要: 目的探讨不同胎龄新生儿出生初期凝血功能检测四项指标的危急值参考范围。方法选取2012年1月1日—2021年12月31日在深圳市3家三级甲等医院住院的新生儿1 110例，按胎龄分为早期早产儿、中期早产儿、晚期早产儿和足月儿，患儿入院24 h内检测凝血功能四项指标。建立新生儿出生初期凝血功能四项指标的危急值参考范围，并依据此范围判断中山大学附属第八医院1 588例新生儿的病情。结果凝血功能危急值参考范围，早期早产儿：活化部分凝血活酶时间(APTT)≥96.6 s或≤46.7 s、凝血酶原时间(PT)≥21.4 s或≤12.5 s、凝血酶时间(TT)≥23.9 s或≤15.7 s、FIB≥3.1 g/L或≤0.9 g/L；中期早产儿：APTT≥92.4 s或≤49.1 s、PT≥18.9 s或≤12.3 s、TT≥23.5 s或≤15.4 s、FIB≥3.0 g/L或≤1.1 g/L；晚期早产儿：APTT≥93.4 s或≤54.8 s、PT≥17.1 s或≤12.5 s、TT≥19.3 s或≤15.3 s、FIB≥2.2 g/L或≤1.1 g/L；足月儿：APTT≥77.6 s或≤42.0 s、PT≥17.4 s或≤12.2 s、TT≥19.0 s或≤14.5 s、FIB≥2.4 g/L或≤1.3 g/L。1 588例新生儿中，早期早产儿危急值检出率为12.61%(14/111)，以呼吸窘迫综合征为主；中期早产儿危急值检出率为10.99%(21/191)，以呼吸窘迫综合征、出血性疾病为主；晚期早产儿危急值检出率为5.33%(25/469)，以高胆红素血症、出血性疾病、窒息为主；足月儿危急值检出率为4.28%(35/817)，以出血性疾病、窒息为主。结论建立不同胎龄新生儿出生初期凝血功能四项指标的危急值参考范围，对重症新生儿病情预测具有重要的参考价值。
- 凝血功能 /
- 生物参考区间 /
- 危急值 /
- 病情预测 /
- 重症新生儿
Abstract: Objective To investigate the critical values of four coagulation indexes in neonates of different gestational ages at the beginning of life. Methods A total of 1 110 eligible newborns hospitalized in 3 level-A tertiary hospitals in Shenzhen from January 1, 2012 to December 31, 2021 were selected. Based on the gestational age, they were divided into early preterm infants, middle preterm infants, late preterm infants and term infants, and four indicators of coagulation function were detected within 24 hours after admission. To establish the reference ranges of four critical values of neonatal coagulation function in the early stage of life, and to determine the condition of 1 588 neonates admitted to the Eighth Affiliated Hospital of Sun Yat-sen University during the same period. Results The critical values of coagulation function in early preterm infants were APTT ≥96.6 s or ≤46.7 s, PT ≥21.4 s or ≤12.5 s, TT ≥23.9 s or ≤15.7 s, FIB ≥3.1 g/L or ≤0.9 g/L; In medium preterm infants were APTT ≥92.4 s or ≤49.1 s, PT ≥18.9 s or ≤12.3 s, TT ≥23.5 s or ≤15.4 s, FIB ≥3.0 g/L or ≤1.1 g/L; In Late premature infants were APTT ≥93.4 s or ≤54.8 s, PT ≥17.1 s or ≤12.5 s, TT ≥19.3 s or ≤15.3 s, FIB ≥2.2 g/L or ≤1.1 g/L; In full-term infants were APTT ≥77.6 s or ≤42.0 s, PT ≥17.4 s or ≤12.2 s, TT ≥19 s or ≤14.5 s, FIB ≥2.4 g/L or ≤1.3 g/L. Among the 1 588 neonates, the detection rate of critical values in early preterm infants was 12.61% (14/111), mainly respiratory distress syndrome; the detection rate of critical values in mid-term preterm infants was 10.99% (21/191), mainly respiratory distress syndrome and neonatal hemorrhagic diseases. The detection rate of critical values in late preterm infants was 5.33% (25/469), mainly neonatal hyperbilirubinemia, neonatal hemorrhagic diseases and neonatal asphyxia. The detection rate of critical values in full-term infants was 4.28% (35/817), mainly neonatal hemorrhagic diseases and neonatal asphyxia. Conclusion The reference ranges of four critical values of coagulation function in neonates with different gestational ages at the early stage of life have been established, which has an important reference value for predicting the condition of severe neonates.
- Coagulation function /
- Biological reference interval /
- Critical value /
- Disease prediction /
- Severe neonates

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表 1 4组新生儿一般情况比较

Table 1. Comparison of general conditions of the four groups of newborns

组别	例数	性别(例)		分娩方式(例)		单胎妊娠(例)		出生体重 [M(P₂₅, P₇₅)，kg]	胎龄 [M(P₂₅, P₇₅)，d]	身长 [M(P₂₅, P₇₅)，cm]
组别	例数	男	女	顺	剖	是	否	出生体重 [M(P₂₅, P₇₅)，kg]	胎龄 [M(P₂₅, P₇₅)，d]	身长 [M(P₂₅, P₇₅)，cm]
早期早产儿	81	41	40	31	50	69	12	1.40(1.24, 1.71)	213.0(206.0, 221.0)	41.0(39.0, 42.6)
中期早产儿	175	85	90	85	90	148	27	1.88(1.69, 2.60)	231.0(227.0, 234.0)	44.0(42.4, 46.2)
晚期早产儿	292	145	147	140	152	276	16	2.48(2.29, 2.73)	250.0(245.0, 254.0)	47.5(46.0, 48.6)
足月儿	509	256	253	301	208	493	16	3.20(2.88, 3.50)	275.0(266.3, 281.5)	49.3(49.0, 49.6)
统计量		0.178^a		19.049^a		40.721^a		691.912^b	910.771^b	886.275^b
P值		0.981		＜0.001		＜0.001		< 0.001	< 0.001	< 0.001
注：^a为χ²值，^b为H值。

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表 2 4组新生儿凝血功能四项指标比较[M(P₂₅, P₇₅)]

Table 2. Comparison of four indicators of neonatal coagulation function among the four groups[M(P₂₅, P₇₅)]

组别	例数	APTT(s)	PT(s)	TT(s)	FIB(g/L)
早期早产儿	81	62.0(54.0, 82.1)	15.6(14.6, 19.2)	19.2(18.0, 21.4)	1.50(1.17, 2.25)
中期早产儿	175	67.7(56.9, 78.7)	15.1(13.4, 16.6)	18.9(16.8, 21.6)	1.59(1.29, 1.99)
晚期早产儿	292	73.7(62.2, 84.5)	14.6(13.3, 15.8)	17.2(16.2, 18.3)	1.50(1.30, 1.80)
足月儿	509	57.6(49.3, 67.7)	14.3(13.3, 15.8)	17.2(16.2, 18.3)	1.50(1.30, 1.80)
H值		169.005	36.616	179.658	12.384
P值		< 0.001	< 0.001	< 0.001	0.006

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表 3 4组新生儿凝血功能指标参考区间(P_2.5~P_97.5)

Table 3. Reference intervals of neonatal coagulation function indexes in the four groups(P_2.5~P_97.5)

组别	例数	APTT(s)	PT(s)	TT(s)	FIB(g/L)
早期早产儿	81	41.9~110.1	11.0~23.8	15.1~26.8	0.84~4.68
中期早产儿	175	39.5~110.0	11.5~20.0	13.0~26.4	0.86~4.10
晚期早产儿	292	47.9~103.1	11.4~19.2	13.4~20.7	0.91~2.41
足月儿	509	36.3~92.4	11.5~19.7	13.4~21.8	1.00~3.00

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表 4 新生儿凝血功能检测指标危急值参考范围

Table 4. Reference ranges for critical values of neonatal coagulation function tests

凝血指标	早期早产儿		中期早产儿		晚期早产儿		足月儿
凝血指标	上限	下限	上限	下限	上限	下限	上限	下限
APTT(s)	≥96.6	≤46.7	≥92.4	≤49.1	≥93.4	≤54.8	≥77.6	≤42.0
PT(s)	≥21.4	≤12.5	≥18.9	≤12.3	≥17.1	≤12.5	≥17.4	≤12.0
TT(s)	≥23.9	≤15.7	≥23.5	≤15.4	≥19.3	≤15.3	≥19.0	≤14.5
FIB(g/L)	≥3.1	≤0.9	≥3.0	≤1.1	≥2.2	≤1.1	≥2.4	≤1.3

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