Page 76 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第41卷第11期
·1638 · Journal of Nanjing Medical University（Natural Sciences） 2021年11月

·临床研究·

围产期妊娠合并中重度血小板减少母儿转归的回顾性研究

张媛媛 ，胥小琴 ，唐晓彤 ，孙丽洲 ，许叶涛 1*
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南京医科大学第一附属医院妇产科，江苏 南京 210029；南京市鼓楼区凤凰社区卫生服务中心，江苏 南京 210029
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［摘 要］ 目的：探讨围产期妊娠合并中重度血小板减少孕妇的妊娠转归情况。方法：回顾性分析 2016 年 1月— 2020 年 12 月
在南京医科大学第一附属医院产科分娩的 214 例妊娠合并血小板减少患者的临床资料，分为妊娠合并轻度血小板减少组
（158 例）与妊娠合并中重度血小板减少组（56例）。结果：妊娠合并轻度血小板减少组与妊娠合并中重度血小板减少组相比，
体重指数、孕次、产次、既往史方面差异无统计学意义（P＞0.05）。但妊娠合并中重度血小板减少患者年龄偏大（P=0.03），血小
板减少症的诊断孕周也早于轻度血小板减少组近7周（P < 0.001），排除分娩方式对产时出血量的影响后，轻度血小板减少组
和中重度血小板减少组间产时出血量差异无统计学意义（P＞0.05）。同时对患者孕期血小板减少的严重程度与产后出血量、
新生儿结局作相关分析，发现孕期血小板减少的严重程度与产后出血和新生儿转归间无相关性（P＞0.05）。在分娩前后凝血
因子变化方面，轻度血小板减少组大多凝血因子指标变化较中重度血小板减少组明显（P＜0.05）。结论：妊娠合并中重度血小
板减少症产妇虽表现为血小板减少，但应结合其他凝血相关指标进行综合评估，如血栓弹力图、凝血5项。因此对于妊娠合并
血小板减少者，特别是中重度患者，需尽早合理有效干预，个体化选择分娩方式，改善母婴结局。
［关键词］ 妊娠合并血小板减少；轻度血小板减少；中重度血小板减少；妊娠结局
［中图分类号］ R714.254 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）11⁃1638⁃06
doi：10.7655/NYDXBNS20211112

Retrospective study on maternal and fetal outcomes of perinatal pregnancy complicated
with moderate and severe thrombocytopenia

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ZHANG Yuanyuan ，XU Xiaoqin ，TANG Xiaotong ，SUN Lizhou ，XU Yetao 1*
1 Department of Obstetrics and Gynecology，the First Affiliated Hospital of Nanjing Medical University，Nanjing
210029；Fenghuang Community Health Service Center，Gulou District，Nanjing 210029，China
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［Abstract］ Objective：This study aims to investigate the pregnancy outcome of pregnant women with moderate and severe
thrombocytopenia in perinatal pregnancy. Methods：the clinical data of 214 pregnant women with thrombocytopenia who delivered in
the obstetrics department of the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were
analyzed retrospectively. They were devided into mild thrombocytopenia group（158 cases）and the pregnancy with moderate to severe
thrombocytopenia group（56 cases）. Results：There was no significant difference in body mass index，pregnancy times，labor times and
history between the pregnancy with mild thrombocytopenia group and the pregnancy with moderate to severe thrombocytopenia group
（P > 0.05）. However，the age of pregnant patients with moderate to severe thrombocytopenia was older（P=0.03），and the gestational
week of thrombocytopenia was nearly 7 weeks earlier than that of mild thrombocytopenia group（P < 0.001）. Excluding the influence of
delivery mode on intrapartum bleeding，there were no significant differences in intrapartum bleeding between mild thrombocytopenia
group and moderate to severe thrombocytopenia group（P > 0.05）. At the same time，the correlation between the severity of
thrombocytopenia during pregnancy and postpartum hemorrhage and neonatal outcome was analyzed. There were no significant
differences in the severity of thrombocytopenia during pregnancy，postpartum hemorrhage and neonatal outcome between two groups
（P > 0.05）. In terms of the changes of coagulation factors before and after delivery，the changes of most coagulation factors in mild
thrombocytopenia group were significantly higher than those in moderate to severe thrombocytopenia group（P < 0.05）. Conclusion：
Although pregnant women with moderate to severe thrombocytopenia show thrombocytopenia，they should be comprehensively

［基金项目］ 国家自然科学基金（81801472，82001578）；江苏省自然科学基金（BK20181080，BK2020040350）
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通信作者（Corresponding author），E⁃mail：xyt110739@163.com