Application Of Low Molecular Weight Heparin Combined With Fresh Frozen Plasma In Abnormal Coagulation Function Of Critically Ill Neonates

Objective To analyze the high-risk factors affecting neonatal coagulation function,to compare the incidence of abnormal coagulation in critically ill and non-critical newborns,and to explore the clinical application effect of low molecular weight heparin combined with fresh frozen plasma in critically ill neonates with coagulation dysfunction.Methods A total of 330 newborns admitted to the neonatal ward of the Hospital from September 2018 to November 2020 were selected.All children were tested for arterial blood gas analysis,biochemical examination and coagulation function within 6 hours after admission,including: coagulation Proenzyme time(PT),activated partial thrombin time(APTT),fibrinogen(FIB),thrombin time(TT),D-dimer(D-D)and platelet(PLT)levels.Divided into critical group(208 cases)and non-critical group(122 cases)according to the scoring method of critically ill neonates;then divided into critical coagulation abnormality group(160 cases)and critical coagulation function group(48cases)according to the abnormal coagulation index,Non-critical coagulopathy group(80 cases),non-critical coagulation function group(42 cases).1.Combined with clinical data,single-factor analysis of various factors that may affect neonatal coagulation function is carried out,and statistically significant factors are analyzed through multi-factor Logistic analysis to explore the risk factors that affect neonatal coagulation function.2.To explore whether there is a difference in the incidence of coagulation abnormalities between the critically ill-grouped newborns and the non-critical coagulation dysfunction group;3.Refer to the International Association of Thrombosis and Hemostasis for the step-by-step diagnosis of diffuse intravascular coagulation and the practical neonatal diagnosis criteria for diffuse intravascular coagulation,formulate the inclusion criteria,select 72 eligible children with critical coagulation abnormalities,after the parents’ informed consent Using random number table method,they were randomly divided into observation group(35 cases)and control group(37 cases).The control group received conventional treatment for the primary disease,and the observation group was treated with low-molecular-weight heparin and fresh frozen plasma on the basis of conventional treatment.The above indicators were retested after 72 hours of treatment.Compare the clinical efficacy,coagulation function indexes and the incidence of complications between the two groups of children.Results 1.In univariate analysis,gender,birth pattern and umbilical cord around neck were not statistically different between the abnormal coagulation group and the normal coagulation group(P >0.05);the difference between birth weight,neonatal asphyxia,hypertension during pregnancy,and premature rupture of membranes was statistically significant between the abnormal coagulation function group and the normal coagulation function group(P <0.05);In the multivariate analysis,neonatal asphyxia(OR=4.130,95% CI:2.073~8.226),premature rupture of membranes(OR=4.084,95%CI:1.872~8.910),gestational hypertension(OR=5.038.95% CI:1.801~14.096),and birth mass(OR=6.633,95% CI : 2.481 ~ 17.733)are high risk factors for abnormal coagulation function in neonates;2.Compared with the non-hazardous group(34.42%),Abnormal coagulation function in the critical group of neonatal incidence(76.92%)was statistically significant(P <0.05%);3.There was no significant difference in PT、APTT、FIB、TT、D-D and PLT levels between observation group and control group before treatment(P >0.05);The PT 、APTT、TT and D-D levels in the observation group were lower than those in the control group after treatment,and the FIB level was higher than that in the control group.The difference between the two groups was statistically significant(P <0.05);There was no significant difference in PLT level between the two groups after treatment(P >0.05).The PT、APTT、TT and D-D levels of the two groups after treatment were lower than those before treatment,and the FIB level was higher than that before treatment.The difference between the two groups was statistically significant(P <0.05);The PLT level of the two groups after treatment was higher than that before treatment,and the difference between the two groups was statistically significant(P <0.05);After 72 hours of treatment,the total effective rate in the observation group was 91.43%,which was higher than 72.97% in the control group.The difference was statistically significant(P<0.05);After 1 week of treatment,the incidence of intracranial hemorrhage,gastrointestinal hemorrhage and pulmonary hemorrhage in the observation group was8.57%,and that in the control group was 24.32%.There was no significant difference between the two groups(P >0.05).Conclusions 1.Abnormal coagulation function of newborns is related to many factors.Among them,birth weight,neonatal asphyxia,hypertension during pregnancy and premature rupture of membranes are high risk factors for abnormal coagulation function of newborns,which must be paid attention to.2.The incidence of abnormal coagulation function is related to the severity of the child’s condition,and the incidence of abnormal coagulation function in critically ill newborns is higher than that in non-critical newborns.It is beneficial to early identification and intervention of children with abnormal coagulation function.3.The early intervention of low molecular weight heparin combined with fresh frozen plasma in the abnormal coagulation function of critically ill newborns can improve the clinical symptoms,restore the coagulation function as soon as possible,and has a good clinical effect.