The Study Of Coagulation Function Changes And Clinical Intervention Of Heparin In Infants Of Hypertensive Disorder Complicating Pregnancy Mothers

Objective: Investigate the clinical features in infants of Hypertensive disorder complicating pregnancy mothers;compare the relationship between the severity of Hypertensive disordercomplicating pregnancy mothers and neonatal coagulation function.Evaluate the effect of heparin in infants of Hypertensive disorder complicating pregnancy mothers.Methods: This is a case-control study,select 225 cases infants from January 2014 to February 2016 in neonatal intensive care unit of Ba Yi Children’s Hospital Affiliated to the General Military Hospital of Beijing PLA,which their mothers have Hypertensive disorder complicating pregnancy,and select same period 100 cases as a control group,their mothers without Hypertensive disorder complicating pregnancy.All neonates are recorded the corresponding clinical manifestations.Between the two groups in gender,childbirth way,mother’s age,there was no significant statistical difference(p>0.05).Within 24 hours we detect the blood coagulation indexes,inclding prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-Dimer(D-D),platelet count(PLT)changes,summarize the clinical features of infants.We select 160 cases of infants with blood coagulation dysfunction from the observation group.We select 90 cases having not Clinical symptoms of hemorrhage from 160 cases.They are randomly divided into heparin intervention group and heparin non-intervention group,45 cases in each group.Two groups all receive routine nursing,reasonable feeding or parenteral nutritional support.According to the situation,we give blood products appropriately.Heparin intervention group give small dose of heparin therapy on the basis of general treatment,the dose is 12.5U/kg/time;Delivery methods: within 24 h after admission:Q6h,Q8 h,24-48 h of admission: admission 48-72h:Q12h,72h-96h:Q24h after discontinuation.Between two groups,gestational age,birth weight and maternal age,gender ratio,the severity of coagulative function has no obvious statistical difference(p>0.05).We select 70 cases significant bleeding in clinical of blood coagulation dysfunction infants.The dose is 50U/kg /times,Q6 h,We give blood products to improve the function of blood coagulation.when the infants have active bleeding,immediately stop using heparin,and detect of blood coagulation function index. When the blood coagulation is improve,we should reduce drug frequency.We test two groups of patients before and after treatment to detect changes of blood coagulation in24 h,48 h,72h.We observe the cure rate and improvement rate.Results:1.In observation group,blood coagulation indexes of PT,APTT,D-D,FDP are significantly higher than that of the control group,but FIB is significantly lower than that of control group,the difference is significant(p<0.05),and PLT between the two groups have no significant difference(p>0.05).2.Btween two groups of infants,PT,APTT,FIB have significant differences in different gestational age groups(p<0.05).When gestational age is increase,PT,APTT are low;FIB is high.With the increase of gestational age,D-D is on the downward trends.The control group,FDP have significant differences in different gestational age groups(p<0.05).PLT in different gestational age groups are no significant difference(p>0.05).3.In 225 cases infants of Hypertensive disorder complicating pregnancy mothers,the incidence of small for gestational age,intracranial hemorrhage,gastrointestinal hemorrhage and DIC is significantly higher than that of the control group,the difference is significant(p<0.05).On birth weight,the difference between the two groups are significant(p<0.05).The incidence of children with pulmonary hemorrhage is higher than the control group,but there is no significant difference(p>0.05).The morbidity of neonatal blood coagulation dysfunction of Hypertensive disorder complicating pregnancy mothers are 71.1%,The morbidity of the skin petechiae,intracranial hemorrhage,gastrointestinal bleeding,pulmonary hemorrhage,DIC,are 11.6%,9.3%,8.4%,7.1%,8.4%,6.2%.4.In terms of the incidence of blood coagulation dysfunction,hypertensive disorder complicating pregnancy group< mild preeclampsia group<severe preeclampsia group <eclampsia group;hypertensive disorder complicating pregnancy group compare with the other three groups,the differences is significant(p<0.05).5.In the intervention group heparin,at different time PT,APTT,FIB,D-D in the don’t phase comparison is statistically significant(p<0.05).After 72 h treatment,the levels of PT,APTT,D-D showe a trend of decline,FIB showes a trend of rise,At the end,PT,APTT,D-D,FIB are back to normal levels.In the treatment group,level of APTT,FIB,D-D at different time are statistically significant(p<0.05).without phase comparison at the same time have statistical significance(p < 0.05).In the treatment group,from initiation to 72 h treatment,APTT,D-D show a trend of decline,after 72 h treatment,APTT,D-D fall to the normal range,FIB rise,back to normal range after 72 h treatment.6.In heparin intervention group,the cure rate(95.6%)is higher than that of the general treatment group(80.0%),the incidence of DIC(0.0%)was lower than the control group(6.6%),the difference is significant(p<0.05).Conclusion:1.In mothers with Hypertensive disorder complicating pregnancy,coagulation function has certain influence in neonates,the newborns coagulation function are in the hypercoagulable state and making it easier for children to develop into low coagulation state,and secondary fibrinolysis hyperfunction.Infants with mother having Hypertensive disorder complicating pregnancy have an increased risk of hemorrhage and DIC.2.In hypertensive disorder complicating pregnancy group,the morbidity rate of the newborn asphyxia,small for gestational age,intrauterine distress,intracranial hemorrhage,DIC are significantly higher.3.The heavier Hypertensive disorder complicating pregnancy is,the higher the risk of the blood coagulation dysfunction and mortality will be.4.The effect of heparin in the treatment of neonatal blood coagulation dysfunction is remarkable,it is more advantageous to improve the function of blood coagulation and reduce the occurrence of DIC.