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目的研究低出生体质量早产儿预防性应用维生素K1后血浆维生素K水平变化,探讨适宜的用药策略。方法将48例胎龄小于<33周的低出生体质量早产儿随机分为2组,一组静脉给予维生素K11mg预防量(静脉组),另一组肌注维生素K11mg预防量(肌注组);出生时即随机抽取其中10例早产儿脐血,采用酶联免疫吸附方法检测脐血及用药24h后血浆维生素K水平,同时检测Ⅱ因子活性。结果出生时仅1例早产儿脐血维生素K水平为1.106μg.L-1;静脉组早产儿血浆维生素K水平明显高于肌注组[(232.149±101.311)μg.L-1vs(104.253±88.426)μg.L-1,P<0.05];2组Ⅱ因子活性比较无统计学差异[(45.62±10.32)%vs(47.71±8.15)%,P>0.05]。结论低出生体质量早产儿出生时处于维生素K低水平状态,提高血浆维生素K水平,不能相应增加Ⅱ因子活性,低出生体质量早产儿维生素K11mg的静脉预防量超过机体需要量,剂量可能偏大。
Objective To study the changes of plasma vitamin K levels after prophylactic administration of vitamin K1 in preterm infants with low birth weight and to explore appropriate strategies. Methods Forty-eight preterm infants of low birth weight less than 33 weeks old were randomly divided into two groups: one group received intravenous vitamin K11mg prophylaxis (vein group) and the other group intramuscular injection of vitamin K11mg prophylaxis group (intramuscular group) ; At birth, randomly selected 10 cases of cord blood of premature children, using enzyme-linked immunosorbent assay cord blood and serum vitamin K levels 24 hours after medication, and test factor II activity. Results The level of vitamin K in umbilical blood was only 1.106μg.L-1 in preterm infants at birth. The plasma vitamin K level in preterm infants with venous blood was significantly higher than that in intramuscular group [(232.149 ± 101.311) μg.L-1vs (104.253 ± 88.426 ) μg.L-1, P <0.05]. There was no significant difference in the activity of factor II between the two groups [(45.62 ± 10.32)% vs (47.71 ± 8.15)%, P> 0.05]. Conclusions Low birth weight preterm infants are born with low levels of vitamin K and can not increase the activity of factor II accordingly. The preventive dose of Vitamin K11mg in preterm infants with low birth weight is higher than the requirement for body weight and the dose may be large .