Oncel Mehmet Yekta, Erdeve Omer, Calisici Erhan, Oguz Serife Suna, Canpolat Fuat Emre, Uras Nurdan, Dilmen Ugur
Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
Pediatr Hematol Oncol. 2013 Apr;30(3):246-52. doi: 10.3109/08880018.2013.771240. Epub 2013 Feb 27.
Although moderate therapeutic hypothermia is the only proven neuroprotective therapy in neonatal hypoxic ischemic encephalopathy secondary to perinatal asphyxia (PA), there is lack of data for its effect on hemostasis. To investigate the effect of neonatal asphyxia on hemostasis and to evaluate the effect of whole body cooling on hematological parameters. Hematological parameters evaluated on the first day of patients with PA before start of hypothermia were compared with those of healthy controls. The effects of whole body cooling on the same parameters were also evaluated on the fourth day. A total of 17 neonates with PA and 15 healthy controls were included. Mean values for prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and d-dimer obtained on the first day were significantly higher in the PA group compared to healthy controls (P ≤ .001 for all comparisons), whereas platelet count, levels of fibrinogen, factors II, V, VII, IX, X, and XI were significantly lower (P ≤ .005 for all comparisons). Levels of factor XIII were normal in both groups. In the study group, mean values for PT, INR, aPTT, and d-dimer evaluated on postnatal day 4 were significantly lower compared to values obtained on the first day of birth in PA group (P < .05 for all comparisons), with statistically significant increases in mean levels of fibrinogen, factor II, V, VII, IX, X, and XII (P < .05 for all comparisons). PA results in significant reductions in levels of factors of the extrinsic pathway and has been associated with thrombocytopenia and disseminated intravascular coagulation. Hypothermia may actually improve the clinical picture in such patients rather than aggravating the hemostatic disturbance, particularly with the implementation of supportive treatment.
尽管中度治疗性低温是围产期窒息（PA）继发的新生儿缺氧缺血性脑病中唯一经证实的神经保护疗法，但关于其对止血功能影响的数据却很匮乏。本研究旨在调查新生儿窒息对止血功能的影响，并评估全身降温对血液学参数的作用。将PA患者在低温治疗开始前第一天评估的血液学参数与健康对照组进行比较。同时也在第四天评估全身降温对相同参数的影响。研究共纳入17例PA新生儿和15例健康对照。PA组第一天测得的凝血酶原时间（PT）、国际标准化比值（INR）、活化部分凝血活酶时间（aPTT）和D-二聚体的平均值显著高于健康对照组（所有比较P≤0.001），而血小板计数、纤维蛋白原水平、因子II、V、VII、IX、X和XI水平显著较低（所有比较P≤0.005）。两组因子 XIII 水平均正常。在研究组中，与PA组出生第一天测得的值相比，出生后第4天评估的PT、INR、aPTT和D-二聚体的平均值显著降低（所有比较P<0.05），纤维蛋白原、因子II、V、VII、IX、X和XII的平均水平有统计学意义的升高（所有比较P<0.05）。PA导致外源性途径因子水平显著降低，并与血小板减少和弥散性血管内凝血有关。低温实际上可能改善此类患者的临床情况，而不是加重止血障碍，尤其是在实施支持性治疗的情况下。
