吴笛,龚晨,兰晶,郭晗,杨静,杨硕,魏瑗,乔蕊.发生胎盘早剥的产妇妊娠期止血系统动态改变与产后出血[J].临床检验杂志,2019,(9):661-665
发生胎盘早剥的产妇妊娠期止血系统动态改变与产后出血
Hemostatic function change and postpartum hemorrhage during women with placental abruption
投稿时间:2019-06-12  修订日期:2019-09-29
DOI:
中文关键词:  胎盘早剥,凝血酶原时间,纤维蛋白原,产后出血
英文关键词:placental abruption  prothrombin time  fibrinogen  postpartum hemorrhage
基金项目:国家自然科学基金项目(面上项目,重点项目,重大项目)
作者单位E-mail
吴笛 北京大学第三医院 nfwudi@163.com 
龚晨 北京大学第三医院  
兰晶 北京大学第三医院  
郭晗 北京大学第三医院  
杨静 北京大学第三医院  
杨硕 北京大学第三医院  
魏瑗 北京大学第三医院  
乔蕊 北京大学第三医院 qrqiaorui@163.com 
摘要点击次数: 552
全文下载次数: 64
中文摘要:
      目的 胎盘早剥是发生产后出血重要危险因素,本研究旨在研究发生胎盘早剥的孕妇在妊娠期止血功能的改变与正常妊娠是否有差异,以及临产前止血功能检测是否有助于产后出血的预测和判断。 方法 连续入选2013年12月1日-2018年12月1日在北京大学第三医院分娩诊断为胎盘早剥的孕妇,同时根据年龄和孕周匹配正常妊娠孕妇作为对照。收集入选产妇的临床资料、产后结局及怀孕至分娩期间所有止血系统检查结果等数据。 结果 本研究连续入选诊断为胎盘早剥的产妇152人,匹配正常妊娠产妇268人。胎盘早剥组PT [10.00 (9.89-10.10) vs 9.86 (9.81-9.92), P=0.023]、APTT [28.52(28.01-29.03)vs 27.10(26.84-27.35), P<0.001]和TT [13.45(13.24-13.67) vs 12.88(12.78-12.97), P<0.001]在孕晚期显著高于正常妊娠组;而纤维蛋白原在临产时低于正常妊娠组[4.11 (3.94-4.28) vs 4.35 (4.28-4.43), P=0.011];FDP和D二聚体在妊娠过程中都呈持续上升趋势,但各期均与正常妊娠无显著差异。临产时仅PT [ (10.2±1.3) vs (9.65±0.53), P=0.020] 和FIB [(3.41±1.29) vs (4.30±0.94), P=0.001] 在产后出血组与未出血组具有显著差异。ROC分析显示,PT和Fib预测判断产后出血的AUC分别为0.632(95% CI 0.517-0.748)和0.703(95% CI 0.596-0.810)。 结论 发生胎盘早剥的孕妇妊娠期的止血系统改变与正常妊娠期的孕妇存在一定差异,临产时的PT和Fib水平对胎盘早剥孕妇是否发生产后出血具有一定预测价值。
英文摘要:
      Objectives Placental abruption is an important risk factor for postpartum hemorrhage. This investigation aimed to study whether there were different changing patterns of hemostatic function during pregnancy between the uncomplicated women and pregnant women with placental abruption. Besides, we also focus on the value of hemostatic function tests for prediction of postpartum hemorrhage. Methods We involved pregnant women diagnosed with placental abruption who delivered at Peking University Third Hospital during December 1st, 2013 to December 1st, 2018. Non-pregnant women were also involved in our study and matched with women with placetnal abruption according to age and gestational age. Medical record, pregnancy outcomes and complete set of hemostatic test results were also collected. Results Our research involved an overall of 152 pregnant women diagnosed with placental abruption and 268 uncomplicated women. Among pregnant women with placental abruption, PT[10.00(9.89-10.10) vs 9.86(9.81-9.92), P=0.023], APTT [28.52(28.01-29.03) vs 27.10(26.84-27.35), P<0.001] and TT [13.45(13.24-13.67) vs 12.88(12.78-12.97), P<0.001] grew significantly higher than the uncomplicated group during the third trimester while fibrinogen level of women with placental abruption [4.11 (3.94-4.28) vs 4.35 (4.28-4.43), P=0.011] was lower than the uncomplicated women at the time of delivery.. Levels of FDP and D-dimer rose throughout gestation but showed no significant difference between women with placental abruption and the uncomplicated women. Only PT[ (10.2±1.3) vs (9.65±0.53), P=0.020] and FIB [(3.41±1.29) vs (4.30±0.94), P=0.001] showed significant difference between the two groups at the time of delivery. The receiver operating characteristic curve showed that the area under the curve of PT was 0.632 (0.517-0.748) in predicting postpartum hemorrhage while AUC of FIB was 0.703 ( 0.596-0.810). Conclusions Different changing pattern of hemostatic system exists between pregant women with placental abruption and uncomplicated women. Levels of FIB and PT at the time of delivery had predictive value in predicting postpartum hemorrhage.
查看全文  查看/发表评论  下载PDF阅读器
关闭