Clinical Effect Of Low Molecular Weight Heparin Sodium On Disseminated Intravascular Coagulation In Neonates With Placental Abruption

Objective: To investigate the pathological changes of coagulation function in neonates;to study the effect of placental abruption on the clinical symptoms and coagulation function of neonates;observation of the effect of low molecular weight heparin sodium on disseminated intravascular coagulation in neonates with placental abruption.Materials and Methods: A total of 50 neonates born from placental abruption pregnant women who were hospitalized in neonatal intensive care unit of the First Affiliated Hospital of Hebei North University from October 2015 to June 2017 were randomly divided into observation group Group and control group,25 cases in each group.Record the history of pregnancy and pregnancy status of selected children with pregnancy and pregnancy status(such as pregnancy several,with or without miscarriage,stillbirth,the history of death from birth,diagnosis and treatment of placental abruption,with or without hypertension,diabetes,placenta previa and other medical history,Radiation exposure,pregnancy environment,history of prenatal medication,etc.),prenatal history of childbirth and birth history(such as gestational age,fetal heart rate monitoring,umbilical cord,placenta,amniotic fluid,etc.mode of delivery,breathing after birth,crying,Apgar score,history of amniotic fluid inhalation,history of intrauterine and postnatal asphyxia and rescue history,birth weight,etc.).The observation group and the control group were given a common comprehensive treatment and nursing,such as active treatment of primary Disease and organ support and protection of treatment,and given oral,umbilical care and timely opening of milk,nutrition,gastrointestinal and other internal and external,so that the subjects met the inclusion criteria.The observation group was treated with low-dose low molecular weight heparin(standard: 0.3ml: 3000 U,0.1ml / 1000U)within 6 hours after admission.The dosage units were all 5U / kg(every 6 hours within 24 hours after admission,48 hours later changed to every 8 hours subcutaneously once;admission within 48-72 hours every 12 hours,72 hours after admission to treatment discontinuation),the observation group,if there was severe hemorrhage of diffuse intravascular coagulation(DIC)during the treatment,the patients were treated with low molecular weight heparin(first dose 100u/kg,6 hours,then 50-100u/kg,every 8 hours,until the coagulation function was corrected or the symptoms of low coagulation stage were discontinued).In the control group,severe diffuse intravascular coagulation symptom was given to the conventional treatment of low molecular weight heparin sodium(the first dose of 100 U / kg,50-100 U / kg every 8 hours).The indicators of coagulation function were monitored at 24 hours,48 hours and 72 hours after admission.Prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen Fibrinogen(FIB),Fibrin degradation products(FDP),D-dimer(D-D),Coagulation inhibitor antithrombin III(AT-III),Platelet count(PLT),and record the corresponding clinical signs.The data collected were statistically analyzed.The statistical significance of each coagulation function index,cure rate,improvement rate,case fatality rate,incidence of DIC,length of hospital stay and adverse reactions of low molecular weight heparin were compared between the two groups.Result:1.By comparing the indicators of coagulation function(PT,APTT,FIB,FDP,DD,AT-III)and clinical manifestations of the two groups,the following results were obtained: The coagulation function of the observation group after low molecular weight heparin treatment(P <0.05).The quality and content of FIB increased compared with that before treatment(P <0.05).There was significant difference between the two groups(P <0.05).With the increase of FIB content,the content of FDP and DD decreased,suggesting that the difference between the two groups was statistically significant(p <0.05);AT-III content also increased at the same time,the difference was statistically significant(p <0.05);2.Comparison of two groups of platelet content(PLT),there was no significant difference between the two groups(p <0.05).3.The cure rate(92%)in the observation group after low molecular weight heparin treatment was higher than that in the control group(60%),there was a significant difference(p <0.05).4.The improvement rate of observation group(96%)was higher than that of control group(68%),there was a significant difference(p <0.05).5.The fatality rate of the two groups was lower than that of the control group(0% vs 16%),the difference was statistically significant(p <0.05).6.The incidence of DIC in observation group(4%)was significantly lower than that in control group(24%),the difference was statistically significant(p <0.05).Conclusion:Pregnant mothers appear early placental exfoliation,can activate the maternal and infant coagulation system,resulting in fetal and neonatal coagulation disorders,newborn after entering the blood that is highly aggregated state of disseminated intravascular coagulation(DIC),due to neonatal clotting itself Mechanism is not yet mature,it is easy to enter the low coagulation period,the final development of fibrinolytic hyperthyroidism,which led to neonatal pulmonary hemorrhage,intracranial hemorrhage,gastrointestinal bleeding,heart and kidney failure and other multiple organ damage,resulting in children Decreased quality of life,increased mortality.At the same time,due to the early placental exfoliation lead to inadequate supply of fetal nutrition,so that placental abortion in neonatal gestational age assessment less than the average birth weight of 10-year-old with the same birth weight,at the same time heart and lung function is not perfect,leading to myocardial damage,newborn HIE,Neonatal apnea syndrome,neonatal respiratory distress syndrome(RDS)and other complications.Therefore,neonatal placental abruption more serious pathological damage,mortality has also greatly improved.This study confirmed that the early application of low molecular weight heparin sodium in neonates with placental abruption can reduce the disseminated intravascular coagulation and coagulation disorders in children with progress,improve the cure rate of children,improve the rate and reduce the mortality of children,DIC Of the incidence,improve children’s quality of life,with good clinical results,can be used to guide clinical medication.