李英 郭玲利 钟卿琳

【摘要】 目的：探索妊娠晚期血浆血小板分布宽度（PDW）、D-二聚体（D-D）及纤维蛋白原（FIB）在高危产妇产后出血中的评估价值。方法：回顾性分析2021年1月—2023年2月瑞金市妇幼保健院产科收治的68例妊娠晚期高危产妇临床资料，均行PDW、D-D、FIB检测，根据观察组产妇产后是否出现产后出血，分为出血组、未出血组。比较两组血清指标，经受试者操作特征（ROC）曲线分析PDW、D-D、FIB预测效能。结果：共46例患者发生产后出血。出血组PDW（16.89±1.43）%、FIB（2.16±0.25）g/L

均低于未出血组，D-D（0.71±0.15）mg/L高于未出血组，差异均有统计学意义（P<0.05）。经ROC曲线分析，PDW、D-D、FIB分别预测高危产妇产后出血的曲线下面积为0.750、0.917、0.925。经二分类logistic回归分析，PDW、D-D、FIB是高危产妇产后出血的影响因素（P<0.05）。结论：检测妊娠晚期高危产妇PDW、D-D、FIB能够较好预测产后出血情况，可作为临床预后评估的重要指标。

【关键词】 纤维蛋白原 D-二聚体 血小板分布宽度 高危产妇 产后出血

The Study of Late Pregnancy Plasma PDW， D-D and FIB in Postpartum Hemorrhage in High-risk Puerpera/LI Ying， GUO Lingli， ZHONG Qinglin. //Medical Innovation of China， 2024， 21（14）： -146

[Abstract] Objective： To explore the evaluation value of late pregnancy plasma platelet distribution width （PDW）， D-dimer （D-D） and fibrinogen （FIB） in the postpartum hemorrhage in high-risk puerpera. Method： Clinical data of 68 high-risk puerpera in the late pregnancy admitted to the Obstetrics Department of Ruijin Maternal and Child Health Care Hospital from January 2021 to February 2023 were retrospectively analyzed， and PDW， D-D and FIB were detected. According to whether postpartum hemorrhage occurred， they were divided into a hemorrhage group and a no-hemorrhage group， and the serum indexes of the two groups were compared. The predictive efficiency of PDW， D-D and FIB was analyzed by receiver operating characteristic （ROC） curve. Result： A total of 46 patients had postpartum hemorrhage. PDW [（16.89±1.43） %] and FIB [（2.16±0.25） g/L] in hemorrhage group were lower than those in no-hemorrhage group， and D-D [（0.71±0.15） mg/L] was higher than that in no-hemorrhage group， the differences were statistically significant （P<0.05）. According to ROC curve analyzed， the area under the carve values predicted by PDW， D-D and FIB were 0.750， 0.917 and 0.925， respectively. The binary logistic regression analysis showed that PDW， D-D and FIB were the influencing factors on postpartum hemorrhage in high-risk puerpera （P<0.05）. Conclusion： Testing PDW， D-D and FIB in high-risk puerpera in late pregnancy can better predict postpartum bleeding and can be used as an important index for clinical prognosis evaluation.

[Key words] Fibrinogen D-dimer Platelet distribution width High-risk puerpera Postpartum hemorrhage

First-author's address： Department of Maternity， Ruijin Maternal and Child Health Care Hospital， Ruijin 342500， China

doi：10.3969/j.issn.1674-4985.2024.14.034

产后出血仍是导致产妇死亡的主要因素，为了降低产妇死亡率，提前准备救治措施，准确预测产后出血风险系数尤为重要[1]。有研究指出，凝血系统与抗凝系统为一个动态平衡，是预防产妇分娩期间大出血关键[2]，过度的激活抗凝或凝血，容易破坏妊娠期间合理的高凝状态，出现出血性疾病，甚至引起致命性产后出血，危及生命安全，对此有学者推测凝血-纤溶系统检测在预测产后出血中具有一定意义[3]。D-二聚体（D-D）、纤维蛋白原（FIB）是临床常用的凝血评估指标，其中FIB是由肝细胞合成转换而成，当机体出血时，可减少消耗体内FIB，从而导致体内该成分蓄积，呈明显上升趋势[4]；D-D是纤维蛋白单体水解后产生的降解产物，当机体出现纤溶、凝血增强时，可出现明显D-D升高，而妊娠女性D-D水平升高明显，尤其是妊娠后期，可表现为纤溶、凝血增强，但当分娩后可逐渐下降；……