作者：張旭東，韓錦玲，賴龍龍，周敏，李漢
【摘要】 目的：探討早產兒凝血功能與顱內出血的關係。方法：對我科住院的123名早產兒凝血功能狀態進行回顧性分組分析，檢測凝血酶原時間（PT）、部分活化凝血活酶時間（APTT）、纖維蛋白原（FIB）含量、血小板數（PBC）及頭顱CT，分析發生顱內出血的幾率，以及胎齡與顱內出血兩者的相關性。結果：早產兒均不同程度存在凝血功能低下情況，與足月兒比較差異有統計學意義，根據胎齡大小分組分析進行統計檢驗，發現胎齡越低凝血功能低下程度越嚴重，發生顱內出血比率越高，早產兒中顱內出血發生57例，占早產兒總數的46.3%，胎齡與早產兒顱內出血呈顯著負相關(γ=-0.338，P<0.01)。討論：凝血功能低下是早產兒常見併發症，是發生顱內出血的重要原因之一，胎齡越低凝血功能低下越嚴重，顱內出血發生率越高。
【關鍵詞】 早產兒；凝血功能；顱內出血
［Abstract］ Objective:To study the relationship between premature infants with low blood coagulation and intracranial hemorrhage.Methods:We took a retrospective group analysis for the coagulation state of the 123 hospitalized premature infants, by the detections of prothrombin time (PT), parttime activation thromboplastin (APTT), fibrinogen (FIB) content, platelet count (PBC) and head CT, to study the relationship between probability of occurrence of intracranial hemorrhage and gestational age.Results: Compared with fullterm infants, the premature infants had varying degrees of lower blood coagulation showing a significant difference. An inspection, based on the gestational age group, found that the lower the gestational age was, the lower the level of blood coagulation would be and the higher the occurrence rate of intracranial hemorrhage was. There were 57 cases of intracranial hemorrhage in premature infants, taking as high as 46.3% of the total number of premature infants. There was a negative correlation between gestational age and intracranial hemorrhage in premature infants (γ=-0.338, P<0.01). Conclusions:Lower blood coagulation is common complication in premature infants, which is one of important reasons for the occurrence of infant intracranial hemorrhage. The lower the gestational age of the infant is, the lower the blood coagulation function is and the higher the rate of intracranial hemorrhage is.
［Key words］ Premature infants;Blood coagulation;Intracranial hemorrhage
早產兒發生顱內出血（ICH）的比例遠比足月兒高，有研究表明，在孕齡不足32周或體重小於1 500 g的低出生兒中，顱內出血的發病率可達40%～50%，死亡率約50%［1］，是嚴重影響早產兒生存及生長發育的常見危險因素，以往多見體重因素、血管及血壓因素等致顱內出血方面的研究，本文擬觀察早產兒凝血功能狀態與顱內出血的關係。
1 資料和方法
1.1 資料及分組
我科對2005年1月至2007年10月本科住院195例早產兒，其中剔除有窒息史的72例，對其他123例（男66例，女57例）按胎齡孕周大小進行分組。第一組：孕周30～32周35例，男20例，女15例；第二組：孕周～34周46例，男22例，女24例；第三組：～37周42例，男24例，女18例；第四組（對照組）：大於37周47例（無窒息缺氧史），男27例，女20例。所有早產兒均為出生當天從婦產科轉入，各組一般情況比較見表1。
1.2 方法
所有患兒入院當天均取股靜脈血2 mL離心分離血漿，測定其部分凝血活酶時間（APTT）、凝血酶原時間 （PT）、纖維蛋白原 （FIB）含量與血小板計數 （BPC），各組患兒分別在產後2～5 d做頭顱CT。正常值：APTT<37 s，PT<13.4 s，FIB 2～4 g/L，BPC100×109 ～300×109，各組檢查結果進行統計學F檢驗。
【摘要】 目的：探討早產兒凝血功能與顱內出血的關係。方法：對我科住院的123名早產兒凝血功能狀態進行回顧性分組分析，檢測凝血酶原時間（PT）、部分活化凝血活酶時間（APTT）、纖維蛋白原（FIB）含量、血小板數（PBC）及頭顱CT，分析發生顱內出血的幾率，以及胎齡與顱內出血兩者的相關性。結果：早產兒均不同程度存在凝血功能低下情況，與足月兒比較差異有統計學意義，根據胎齡大小分組分析進行統計檢驗，發現胎齡越低凝血功能低下程度越嚴重，發生顱內出血比率越高，早產兒中顱內出血發生57例，占早產兒總數的46.3%，胎齡與早產兒顱內出血呈顯著負相關(γ=-0.338，P<0.01)。討論：凝血功能低下是早產兒常見併發症，是發生顱內出血的重要原因之一，胎齡越低凝血功能低下越嚴重，顱內出血發生率越高。
【關鍵詞】 早產兒；凝血功能；顱內出血
［Abstract］ Objective:To study the relationship between premature infants with low blood coagulation and intracranial hemorrhage.Methods:We took a retrospective group analysis for the coagulation state of the 123 hospitalized premature infants, by the detections of prothrombin time (PT), parttime activation thromboplastin (APTT), fibrinogen (FIB) content, platelet count (PBC) and head CT, to study the relationship between probability of occurrence of intracranial hemorrhage and gestational age.Results: Compared with fullterm infants, the premature infants had varying degrees of lower blood coagulation showing a significant difference. An inspection, based on the gestational age group, found that the lower the gestational age was, the lower the level of blood coagulation would be and the higher the occurrence rate of intracranial hemorrhage was. There were 57 cases of intracranial hemorrhage in premature infants, taking as high as 46.3% of the total number of premature infants. There was a negative correlation between gestational age and intracranial hemorrhage in premature infants (γ=-0.338, P<0.01). Conclusions:Lower blood coagulation is common complication in premature infants, which is one of important reasons for the occurrence of infant intracranial hemorrhage. The lower the gestational age of the infant is, the lower the blood coagulation function is and the higher the rate of intracranial hemorrhage is.
［Key words］ Premature infants;Blood coagulation;Intracranial hemorrhage
早產兒發生顱內出血（ICH）的比例遠比足月兒高，有研究表明，在孕齡不足32周或體重小於1 500 g的低出生兒中，顱內出血的發病率可達40%～50%，死亡率約50%［1］，是嚴重影響早產兒生存及生長發育的常見危險因素，以往多見體重因素、血管及血壓因素等致顱內出血方面的研究，本文擬觀察早產兒凝血功能狀態與顱內出血的關係。
1 資料和方法
1.1 資料及分組
我科對2005年1月至2007年10月本科住院195例早產兒，其中剔除有窒息史的72例，對其他123例（男66例，女57例）按胎齡孕周大小進行分組。第一組：孕周30～32周35例，男20例，女15例；第二組：孕周～34周46例，男22例，女24例；第三組：～37周42例，男24例，女18例；第四組（對照組）：大於37周47例（無窒息缺氧史），男27例，女20例。所有早產兒均為出生當天從婦產科轉入，各組一般情況比較見表1。
1.2 方法
所有患兒入院當天均取股靜脈血2 mL離心分離血漿，測定其部分凝血活酶時間（APTT）、凝血酶原時間 （PT）、纖維蛋白原 （FIB）含量與血小板計數 （BPC），各組患兒分別在產後2～5 d做頭顱CT。正常值：APTT<37 s，PT<13.4 s，FIB 2～4 g/L，BPC100×109 ～300×109，各組檢查結果進行統計學F檢驗。