【摘要】 目的了解早产儿是否存在维生素K(VitK)依赖因子水平低下及其与早产儿脑室周围-脑室内出血的关系,探讨产前应用VitK1对早产儿脑室周围-脑室内出血的预防效果。方法将有可能早产且至分娩时孕周不足34周的孕妇分为两组:地塞米松(Dex)组118例,在产前给予Dex注射;Dex+VitK1组80例,产前给予Dex及VitK1。两组早产儿各40例留取脐动脉血离心取血清-20℃保存,用凝固法检测凝血因子II、VIII、X、X的活性,同时留取同期出生的健康足月新生儿40例脐血标本作对照。早产儿生后1周内常规做头颅超声检查明确有无脑室周围-脑室内出血及其程度。结果Dex组脐血VitK依赖因子II、VII、IX、X的活性水平分别为(25.1±10.4)%(、58.1±16.9)%(、23.8±9.8)%(、29.6±8.7)%,Dex+VitK1组分别为(36.2±9.4)%、(69.3±17.1)%、(25.4±10.1)%(、39.8±9.1)%,足月儿分别为(37.1±5.9)%(、65.8±13.5)%(、29.7±7.3)%、(37.6±11.3)%。Dex组与足月儿组比较,VitK依赖因子活性水平有显著性差异(P<0.05)。Dex组与Dex+VitK1组比较,II、VII、X因子活性水平有显著性差异(P<0.05)。脑室周围-脑室内出血发生率Dex组为52.5%,Dex+VitK1组为32.5%(χ2=7.76,P<0.05);重度出血发生率Dex组为12.7%,Dex+VitK1组为2.5%(χ2=6.33,P<0.05)。结论早产儿存在VitK依赖因子水平低下,可能是其易于发生脑室周围-脑室内出血的原因之一。分娩前母亲补充VitK1可显著提高其血浆II、VII和X因子水平,并对脑室周围-脑室内出血有一定预防作用。更多还原

【Abstract】 Objective To investigate the relationship between the low concentrations of vitamin K-dependent coagulation factors and the peri-intraventricular hemorrhage（PIVH） in preterm infant,and the effect of maternal prenatal administration of vitamin K on preventing PIVH in preterm infants.Methods Pregnant women of preterm labor at less than 34 weeks of gestational age were randomly divided into two groups:Dex group had 118 cases which were given Dex injections;Dex+VitK₁ group had 80 cases which were given Dex+VitK₁.During the same period,forty full-term neonates were as control.Cord blood samples of three groups were obtained to determine coagulation factors II,IIV,IX and X.The cranial ultrasound was performed by a same physician to detect whether the neonates were complicated with PIVH and to determine its severity.Results The activities of Vitamin K-dependent coagulation factors were II（25.1±10.4）%,VII（58.1±16.9）%,IX（23.8±9.8）%,X（29.6±8.7）% in Dex group,were II（36.2±9.4）%,VII（69.3±17.1）%,IX（25.4±10.1）%,X（39.8±9.1）% in Dex+VitK₁ group and were II（37.1±5.9）%,VII（65.8±13.5）%,IX（29.7±7.3）%,X（37.6±11.3）% in full-term group.The levels of Vitamin K-dependent coagulation factors in umbilical blood had significant difference between the Dex group and the full-term infants（P<0.05）.The levels of coagulation factors II,IIV,IX were higher significanty in Dex+VitK₁ group than that in Dex group（P<0.05）.The total incidence of PIVH in Dex+VitK₁ group and Dex group were 32.5% and 52.5%,respectively（P<0.05）,and the frequencies of severe PIVH in two groups were 2.5% and 12.7%,respectively（P<0.05）.Conclusion Preterm infants have decreased activities of Vitamin K-dependent coagulation factors which is one of the reasons of PIVH.Prophylactic administration of Vitamin K1 to pregnant women can improve the activities of Vitamin K-dependent coagulation factors II,VII,and X in preterm infant,and has effect on preventing PIVH.更多还原