不同分娩方式下妊娠晚期及产褥期凝血五项变化及意义

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摘要目的探讨不同分娩方式下妊娠晚期及产褥期血浆凝血五项的变化及意义，以指导产科静脉血栓栓塞症的防治。方法回顾性分析2019年1月至5月江苏省扬州市妇幼保健院1216例足月分娩的健康单胎产妇的临床资料。按照分娩方式分为顺娩组（661例）、剖宫产组（515例）、产钳组（40例）。比较妊娠晚期（分娩前7 d内）、产褥期（分娩后48 h）凝血五项水平。结果妊娠晚期，三组凝血五项结果比较，差异无统计学意义（P ＞ 0.05）。产褥期，顺娩组凝血酶时间（TT）短于妊娠晚期，纤维蛋白原（FIB）水平高于妊娠晚期，D-二聚体（DDI）水平低于妊娠晚期，差异有统计学意义（P ＜ 0.05）；剖宫产组凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）长于妊娠晚期，TT短于妊娠晚期，FIB水平高于妊娠晚期，DDI水平低于妊娠晚期，差异有统计学意义（P ＜ 0.05）；产钳组PT长于妊娠晚期，FIB水平高于妊娠晚期，差异有统计学意义（P ＜ 0.05）。剖宫产组PT、APTT长于顺娩组，FIB水平高于顺娩组，TT短于顺娩组；产钳组PT、APTT短于剖宫产组，FIB水平低于剖宫产组，差异有统计学意义（P ＜ 0.05）。结论根据正常人群的凝血五项标准，妊娠晚期及产褥期孕产妇的凝血五项中PT、APTT、TT均在正常值范围，但FIB、DDI水平高于正常值范围，符合血液高凝状态的结论。不推荐产后常规筛查DDI水平作为预测产褥期静脉血栓栓塞疾病的依据。剖宫产的产妇产褥期PT、APTT长于妊娠晚期，出现低凝状态的现象。

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	张静张琳任卫娟

关键词 ：妊娠晚期, 产褥期, 凝血五项, 高凝状态, 深静脉血栓

Abstract：Objective To investigate the changes and significance of five items of coagulation in third trimester of pregnancy and puerperium under different delivery modes in order to the prevention and treatment of obstetric venous thromboembolism. Methods The clinical data of 1216 healthy single parturient women who delivered at term in Yangzhou Maternal and Child Health Hospital from January to May 2019 were retrospectively analyzed. According to the delivery mode, they were divided into delivery group (661 cases), cesarean section group (515 cases) and forceps group (40 cases). Five items of coagulation levels were compared during third trimester of pregnancy (within seven days before delivery) and puerperium (48 h after delivery). Results In the third trimester of pregnancy, there were no significant differences in five items of coagulation among three groups (P > 0.05). During puerperium, thrombin time (TT) in delivery group was shorter than that in the third trimester of pregnancy, fibrinogen (FIB) level was higher than that in the third trimester of pregnancy, D-dimer (DDI) level was lower than that in the third trimester of pregnancy, and the differences were statistically significant (P < 0.05); prothrombin time (PT) and activated partial prothrombin time (APTT) in cesarean section group were longer than those in the third trimester of pregnancy, TT was shorter than that in the third trimester of pregnancy, FIB level was higher than that in the third trimester of pregnancy, DDI level was lower than that in the third trimester of pregnancy, and the differences were statistically significant (P < 0.05); PT in the forceps group was longer than that in the third trimester of pregnancy, and FIB level was higher than that in the third trimester of pregnancy, and the differences were statistically significant (P < 0.05). PT and APTT in cesarean section group were longer than those in delivery group, FIB level was higher than that in delivery group, TT was shorter than that in delivery group; PT and APTT in forceps group were shorter than those in cesarean section group, while FIB level was lower than that in cesarean section group, and the differences were statistically significant (P < 0.05). Conclusion According to the five standards of coagulation for normal people, PT, APTT, and TT of the five items of coagulation in third trimester of pregnancy and puerperium pregnant women are all within the normal range, but FIB and DDI level are higher than the normal range, which is in line with the conclusion of blood hypercoagulability. Routine postpartum screening of DDI levels is not recommended as a basis for predicting venous thromboembolism disease in the puerperium. PT and APTT in puerperium of cesarean delivery pregnancy are longer than those in the third trimester of pregnancy, and the phenomenon of hypocoagulability appears.

Key words： Third trimester of pregnancy Puerperium Five items of coagulation Hypercoagulable state Deep venous thrombosis

基金资助:江苏省卫生和计划生育委员会妇幼健康重点人才项目（FRC201729）。

通讯作者: 任卫娟（1964.10-），女，主任医师，硕士生导师；研究方向：围生医学。

引用本文:

张静张琳任卫娟. 不同分娩方式下妊娠晚期及产褥期凝血五项变化及意义[J]. 中国医药导报, 2022, 19(6): 98-101.
ZHANG Jing ZHANG Lin REN Weijuan. Changes and significance of five items of coagulation in third trimester of pregnancy and puerperium under different delivery modes#br#. 中国医药导报, 2022, 19(6): 98-101.

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https://www.yiyaodaobao.com.cn/CN/ 或 https://www.yiyaodaobao.com.cn/CN/Y2022/V19/I6/98

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