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目的探讨胎盘早剥早产儿使用普通肝素防治凝血功能异常的最合理剂量。方法纳入60例胎盘早剥早产儿,随机分为3组,分别给予不同剂量普通肝素。A组用0.1 mg·kg-1普通肝素、B组用0.2 mg·kg-1普通肝素、C组用0.3 mg·kg-1普通肝素。给药方法:入院24 h,每6 h 1次;入院24～48 h,每8 h 1次;入院48～72 h,每12 h 1次;72 h后每日1次至停用,或直接停用普通肝素。检测入院未使用普通肝素时及使用普通肝素24 h、72 h凝血功能及血小板计数,记录临床体征。结果 3组早产儿颅内出血、坏死性小肠结肠炎、新生儿黄疸、住院天数、治愈率比较差异均无统计学意义(Pa>0.05)。A组、B组、C组使用普通肝素24 h凝血功能检测值及血小板计数比较差异均无统计学意义(Pa>0.05);A组、B组、C组使用普通肝素72 h凝血功能检测值及血小板计数差异均无统计学意义(Pa>0.05);各项指标在各组使用普通肝素前、使用24 h、72 h之间比较,活化部分凝血酶原时间差异均有统计学意义(Pa<0.05);凝血酶原时间在A组、B组用药前后差异均有统计学意义(Pa<0.05);D-二聚体、纤维蛋白原在A组用药前后差异均有统计学意义(Pa<0.05);血小板计数在C组用药前后差异均有统计学意义(Pa<0.05)。结论普通肝素0.1 mg·kg-1是胎盘早剥早产新生儿防治凝血功能异常的最合理剂量,0.1～0.3 mg·kg-1剂量均安全、有效。
Objective To investigate the most reasonable dose of unfractionated heparin in preventing and treating coagulation dysfunction in premature infants with placental abruption. Methods Sixty preterm infants with placental abruption were enrolled and randomly divided into three groups. All patients were given different doses of unfractionated heparin. A group with 0.1 mg · kg-1 unfractionated heparin, B group with 0.2 mg · kg-1 unfractionated heparin, C group with 0.3 mg · kg-1 unfractionated heparin. Method of administration: Admission 24 h, every 6 h 1; admission 24 to 48 h, every 8 h; 48 to 72 h admission, every 12 h 1; 72 h after the daily 1 to disable, or Direct disable generic heparin. All patients were admitted to hospital without unfractionated heparin and unfractionated heparin 24 h, 72 h coagulation and platelet count, and the clinical signs were recorded. Results There were no significant differences in the rates of intracranial hemorrhage, necrotizing enterocolitis, neonatal jaundice, days of hospitalization and cure rate in the three groups (Pa> 0.05). In group A, group B, group C, unfractionated heparin 24 h coagulation test and platelet count showed no significant difference (Pa> 0.05); Group A, B and C used unfractionated heparin 72 h coagulation test (P> 0.05). Before the use of unfractionated heparin in each group, the differences of the prothrombin time between the two groups were statistically significant (Pa (P <0.05). The prothrombin time was significantly different between group A and group B before and after treatment (Pa <0.05). The difference of D-dimer and fibrinogen in group A before and after treatment was statistically significant (Pa <0.05). There was significant difference in platelet count before and after treatment in group C (Pa <0.05). Conclusion Unfractionated heparin 0.1 mg · kg-1 is the most reasonable dose for prevention and treatment of coagulation dysfunction in premature newborns with placental abruption. The dose of 0.1 ~ 0.3 mg · kg-1 is safe and effective.