标题：血栓弹力图联合凝血指标对早产儿凝血功能的评估价值

      作者：罗素云 1，何成龙 1，陈钊毅 1，王琴 2，许春华 1    1.东莞市厚街医院新生儿科，广东 东莞 523945；2.中山大学附属孙逸仙纪念医院新生儿科，广东 广州 510120

      卷次： 2020年31卷16期

      【摘要】 目的 探究血栓弹力图联合凝血指标对早产儿凝血功能的评估效果。方法 选取 2017年 6月至2019年6月期间在东莞市厚街医院及中山大学附属孙逸仙纪念医院分娩的110例单胎新生儿为研究对象，将其中50例早产儿(胎龄<37周)设为早产组，其余60例足月儿(胎龄≥37周)设为足月组。并依据常规凝血功能检查将新生儿分为观察组(凝血功能异常，48例)和对照组(凝血功能正常，62例)。所有新生儿均进行常规凝血功能检查及血栓弹力图检查，分别对早产组与足月组新生儿、观察组与对照组新生儿的血浆凝血功能指标及血栓弹力图相关凝血功能指标进行比较，并对上述各指标与早产儿凝血功能的相关性行Spearman相关分析。结果 早产组新生儿的血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)水平明显高于足月组新生儿，血浆纤维蛋白原(FIB)水平明显低于足月组新生儿，差异有统计学意义(P<0.05)。早产组新生儿与足月组新生儿的血细胞凝集块形成速率(α角)比较差异无统计学意义(P>0.05)。早产组新生儿的凝血反应时间(R)、血块形成时间(K)、血凝块最大强度(MA)、纤活指数(EPL)、凝血幅度下降速率(LY30)水平高于足月组新生儿，凝血综合指数(CI)值低于足月组新生儿，差异有统计学意义(P<0.05)。观察组新生儿的血浆PT、APTT、TT水平高于对照组新生儿，血浆FIB水平低于对照组新生儿，差异有统计学意义(P<0.05)。观察组新生儿与对照组新生儿的α角比较差异无统计学意义(P>0.05)。观察组新生儿的R、K、MA、EPL、LY30水平高于对照组新生儿，CI值低于对照组新生儿，差异有统计学意义(P<0.05)。血浆PT、APTT、TT水平、R、K、MA、EPL、LY30水平与早产儿凝血功能均呈正相关(P<0.05)，血浆FIB、CI值与早产儿凝血功能呈负相关(P<0.05)。结论 血栓弹力图与血浆凝血指标对早产儿凝血功能均有一定的评估效果，两种检查中的部分参数均与早产儿凝血功能存在相关性，各指标联合检测具有一定临床指导意义。
      【关键词】 早产；凝血功能；凝血指标；血栓弹力图；评估
      【中图分类号】 R722 【文献标识码】 A 【文章编号】 1003—6350（2020）16—2089—04

Evaluation value of thromboelastography combined with coagulation index on coagulation function of prematureinfants.
LUO Su-yun 1, HE Cheng-long 1, CHEN Zhao-yi 1, WANG Qin 2, XU Chun-hua 1. 1. Department of Neonatology,the Houjie Hospital of Dongguan City, Dongguan 523945, Guangdong, CHINA; 2. Department of Neonatology, Sun Yat-senMemorial Hospital Affiliated to Sun Yat-sen University, Guangzhou 510120, Guangdong, CHINA
【Abstract】 Objective To investigate the evaluation effect of thromboelastography (TEG) combined with coag-ulation index on coagulation function of premature infants. Methods A total of 110 single-birth neonates born in Hou-jie Hospital of Dongguan City and Sun Yat-sen Memorial Hospital Affiliated to Sun Yat-sen University from June 2017to June 2019 were selected as the research object, and 50 of them born prematurely (gestational age <37 weeks) were setas preterm group, the remaining 60 full-term children (gestational age≥ 37 weeks) were set as full-term group. And ac-cording to the routine coagulation test, the newborns were divided into the observation group (abnormal coagulationfunction, n=48) and the control group (normal coagulation function, n=62). All neonates undergo routine coagulationfunction examination and thrombus elasticity examination, and the plasma coagulation function indexes and thrombuselasticity chart-related coagulation function indexes of neonates in the preterm and full-term groups, as well as the obser-vation group and the control group were compared. Spearman correlation analysis was performed on the correlation be-tween the above indexes and the coagulation function of premature infants. Results The levels of plasma prothrombintime (PT), activated partial prothrombin time (APTT), and thrombin time (TT) in the preterm group were significantlyhigher than those in the full-term group, while the plasma fibrinogen (FIB) level was significantly lower than that in thefull-term group (all P<0.05). There was no statistically significant difference in the rate of hemagglutination (α angle) be-tween the preterm group and the term group (P>0.05). The coagulation reaction time (R), clot formation time (K), bloodclot maximum intensity (MA), fibrillation index (EPL), and rate of decrease in coagulation amplitude (LY30) in the pre-term group were significantly higher than those in the full-term group, while the coagulation comprehensive index (CI)value was significantly lower than that of full-term neonates (all P<0.05). Plasma PT, APTT and TT levels in the observa-tion group were significantly higher than those in the control group, and plasma FIB levels were significantly lower thanthose in the control group (all P<0.05). There was no significant difference in α angle between the observation group andthe control group (P>0.05). The R, K, MA, EPL, and LY30 levels of the newborns in the observation group were signifi-