CAJ | 학술논문

目的分析临产孕妇的产前凝血功能检查指标，探讨这些指标与产后大出血的相关性。方法选取2011年3月-2012年3月间本院临产产妇183例，另选取非孕产妇158例作为对照组。收集两组的纤维蛋白原(Fg)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、D-二聚体(DD)、抗凝血酶Ⅲ(AT-Ⅲ)等出凝血功能检查指标和临床资料。分析两组间及孕产妇组内产后出血组与非出血组间实验室检查指标差异性。结果 PT、TT、AT-Ⅲ明显低于对照组，Fg和DD水平明显高于对照组；发生了产后大出血的孕妇的出凝血指标Fg、DD及AT-Ⅲ与未发生产后大出血的孕妇组相比差异具有统计学意义(P <0.05)，以Fg≥7.00g/L来诊断产后大出血，其阳性预测值是87.5%，阴性预测值是82.3%；以 AT-Ⅲ≤205mg/L，其阳性预测值是85.7%，阴性预测值是82.0%；而以DD≥650mg/L，其阳性预测值和阴性预测值均是100%。结论临产孕妇的凝血功能指标与非孕产妇相比有显著差别，根据产前监测Fg、DD及AT-Ⅲ的浓度水平对预测产妇产后大出血有重要意义。
목적분석임산잉부적산전응혈공능검사지표，탐토저사지표여산후대출혈적상관성。방법선취2011년3월-2012년3월간본원임산산부183례，령선취비잉산부158례작위대조조。수집량조적섬유단백원(Fg)、응혈매원시간(PT)、활화부분응혈매시간(APTT)、D-이취체(DD)、항응혈매Ⅲ(AT-Ⅲ)등출응혈공능검사지표화림상자료。분석량조간급잉산부조내산후출혈조여비출혈조간실험실검사지표차이성。결과 PT、TT、AT-Ⅲ명현저우대조조，Fg화DD수평명현고우대조조；발생료산후대출혈적잉부적출응혈지표Fg、DD급AT-Ⅲ여미발생산후대출혈적잉부조상비차이구유통계학의의(P <0.05)，이Fg≥7.00g/L래진단산후대출혈，기양성예측치시87.5%，음성예측치시82.3%；이 AT-Ⅲ≤205mg/L，기양성예측치시85.7%，음성예측치시82.0%；이이DD≥650mg/L，기양성예측치화음성예측치균시100%。결론임산잉부적응혈공능지표여비잉산부상비유현저차별，근거산전감측Fg、DD급AT-Ⅲ적농도수평대예측산부산후대출혈유중요의의。
Objective To analyze the indicators of coagulation function in pregnant women and evaluate the correlation between the indicators of coagulation function in pregnant women and the postpartum hemorrhage. Methods 183 cases of pregnant women were selected from March 2011 to March 2012 in our hospital as the research object, 158 cases of healthy pregnant women were checked up in the same period in our hospital as the control group. Fibrinogen(Fg) level, prothrombin time(PT), thrombin time(TT), activate part of thrombin time(APTT), the d-dimmer and anticoagulant Ⅲ enzyme(AT-Ⅲ) activity of two groups were detected. Differences of laboratory parameters were analyzed within the two groups and between the group of maternal postpartum hemorrhage group and the non-bleeding group. Results The index of PT, TT was significantly shorten, AT-Ⅲ activity decreased significantly, the level of Fg and d-dimmer significantly higher than those in the control group, the difference were statistically significant(P <0.05). If the level of Fg≥7.00g/L was acted as the diagnosis level of postpartum hemorrhage, the positive predictive value(PPV) is 87.5% and the negative predictive value(NPV) is 82.3%. If the level of AT-Ⅲ ≤205mg/L, the PPV and NPV are 85.7% and 82.0% respectively. However, if the level of DD is above 650mg/L, the PPV and NPV are 100%. Conclusions The difference of coagulation parameters between the pregnant women and non-pregnant women is significant, it is important to predict postpartum hemorrhage according to the prenatal detection level of Fg, DD and AT-Ⅲ.