中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2012年
8期
736-740
,共5页
温隽珉%陈怀生%孙育欣%潘晓华
溫雋珉%陳懷生%孫育訢%潘曉華
온준민%진부생%손육흔%반효화
弥漫性血管内凝血%肝素,低分子量%病死率
瀰漫性血管內凝血%肝素,低分子量%病死率
미만성혈관내응혈%간소,저분자량%병사솔
Disseminated intravascular coagulation%Heparin,low molecular weight%Mortality
目的 探讨对严重创伤性弥漫性血管内凝血( DIC)使用小剂量普通肝素或低分子肝素( LM WHs)的临床疗效. 方法 选择77例我院ICU收治、APACHEⅡ评分5～ 10分且并发DIC的患者,按随机数字表法分为三组:A组(26例)为LMWHs组(75～150U·kg-1 ·d-1,初始平均剂量4 000 U/d)；B组(25例)为普通肝素组(100～250 U·kg-1·d-1,初始平均剂量5 000 U/d),皮下注射根据抗凝血酶Ⅲ(ATⅢ)水平调整用量；对照组(26例)为单纯凝血因子补充组.比较各组在ICU 28 d内的病死率、住院天数、出血事件发生率和凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血酶时间(APTr)、纤维蛋白原(Fg)、ATⅢ及D-二聚体. 结果 三组28 d病死率比较:A组与对照组比较,B组与对照组比较,差异均有统计学意义(P＜0.05)；(2)ICU住院天数:三组比较差异有统计学意义(P＜0.01),A、B组长于对照组(P＜0.01),A组长于B组(P＜0.05)；(3)凝血指标:除ATⅢ(P＜0.01)外,其他指标间比较,差异无统计学意义意义；(4)出血率:A组与对照组比较,差异无统计学意义(P＞0.05)；B组与对照组比较,差异有统计学意义(P＜0.05),A组与B组比较差异统计学意义(P＜0.05)；(5)相关因素分析显示血浆ATⅢ与出血率相关明显(P＜0.01). 结论 使用肝素或LMWHs有助控制外伤性DIC,采用与出血率具有明显相关性的ATⅢ来调整肝素的用法比LMWHs具有更低的出血率.
目的 探討對嚴重創傷性瀰漫性血管內凝血( DIC)使用小劑量普通肝素或低分子肝素( LM WHs)的臨床療效. 方法 選擇77例我院ICU收治、APACHEⅡ評分5～ 10分且併髮DIC的患者,按隨機數字錶法分為三組:A組(26例)為LMWHs組(75～150U·kg-1 ·d-1,初始平均劑量4 000 U/d)；B組(25例)為普通肝素組(100～250 U·kg-1·d-1,初始平均劑量5 000 U/d),皮下註射根據抗凝血酶Ⅲ(ATⅢ)水平調整用量；對照組(26例)為單純凝血因子補充組.比較各組在ICU 28 d內的病死率、住院天數、齣血事件髮生率和凝血酶時間(TT)、凝血酶原時間(PT)、活化部分凝血酶時間(APTr)、纖維蛋白原(Fg)、ATⅢ及D-二聚體. 結果 三組28 d病死率比較:A組與對照組比較,B組與對照組比較,差異均有統計學意義(P＜0.05)；(2)ICU住院天數:三組比較差異有統計學意義(P＜0.01),A、B組長于對照組(P＜0.01),A組長于B組(P＜0.05)；(3)凝血指標:除ATⅢ(P＜0.01)外,其他指標間比較,差異無統計學意義意義；(4)齣血率:A組與對照組比較,差異無統計學意義(P＞0.05)；B組與對照組比較,差異有統計學意義(P＜0.05),A組與B組比較差異統計學意義(P＜0.05)；(5)相關因素分析顯示血漿ATⅢ與齣血率相關明顯(P＜0.01). 結論 使用肝素或LMWHs有助控製外傷性DIC,採用與齣血率具有明顯相關性的ATⅢ來調整肝素的用法比LMWHs具有更低的齣血率.
목적 탐토대엄중창상성미만성혈관내응혈( DIC)사용소제량보통간소혹저분자간소( LM WHs)적림상료효. 방법 선택77례아원ICU수치、APACHEⅡ평분5～ 10분차병발DIC적환자,안수궤수자표법분위삼조:A조(26례)위LMWHs조(75～150U·kg-1 ·d-1,초시평균제량4 000 U/d)；B조(25례)위보통간소조(100～250 U·kg-1·d-1,초시평균제량5 000 U/d),피하주사근거항응혈매Ⅲ(ATⅢ)수평조정용량；대조조(26례)위단순응혈인자보충조.비교각조재ICU 28 d내적병사솔、주원천수、출혈사건발생솔화응혈매시간(TT)、응혈매원시간(PT)、활화부분응혈매시간(APTr)、섬유단백원(Fg)、ATⅢ급D-이취체. 결과 삼조28 d병사솔비교:A조여대조조비교,B조여대조조비교,차이균유통계학의의(P＜0.05)；(2)ICU주원천수:삼조비교차이유통계학의의(P＜0.01),A、B조장우대조조(P＜0.01),A조장우B조(P＜0.05)；(3)응혈지표:제ATⅢ(P＜0.01)외,기타지표간비교,차이무통계학의의의의；(4)출혈솔:A조여대조조비교,차이무통계학의의(P＞0.05)；B조여대조조비교,차이유통계학의의(P＜0.05),A조여B조비교차이통계학의의(P＜0.05)；(5)상관인소분석현시혈장ATⅢ여출혈솔상관명현(P＜0.01). 결론 사용간소혹LMWHs유조공제외상성DIC,채용여출혈솔구유명현상관성적ATⅢ래조정간소적용법비LMWHs구유경저적출혈솔.
Objective To discuss the clinical efficacy of low dose heparins and low molecular weight heparins (LMWHs) in the treatment of severe traumatic disseminated intravascular coagulation (DIC). Methods A total of 77 trauma patients (APACHE Ⅱ score for 5-10) with secondary DIC in ICU were included and randomly assigned to three groups,ie,Group A (26 patients,subcutaneously injected with LMWHs at doses of 75-150 U · kg-1 · d-1,with the average incipient dose of 4 000 U/d),Group B (25 patients,subcutaneously injected with heparins at doses of 100-250 U · kg-1 · d-1,with the average incipient dose of 5000 U/d and control group (26 patients,supplemented with simple blood coagulation factor).The injection volume was adjusted according to the level of antithrombin Ⅲ ( ATⅢ ) in each group.Within 28 days in ICU,the three groups were compared in aspects of deaths,hospital day,bleeding rate,thrombin time (TT),prothrombin time (PT),activation part thrombin time ( APTT),fibrinogen (Fg),antithrombin Ⅲ ( AT Ⅲ ) and D-dimer. Results ( 1 ) The differences of mortality were both insignificant in the control group comparel with Group A and Group B respectively at day 28 ( P ＜ 0.05 ).(2) The ICU stay of three groups showed significant differences ( P ＜ 0.01 ),with longer stay of Groups A and B than control group ( P ＜ 0.01 ) and longer stay of Group A than Group B ( P ＜ 0.05 ).( 3 ) Except for AT Ⅲ ( P ＜ 0.01 ),other blood coagulation indices showed no significant difference among three groups.(4) The differences of bleeding rate were not significant between Group A and control group (P ＞ 0.05),but significant between Group B and control group (p ＜ 0.05 ).(5) Related factor analysis indicated significant relationship between AT Ⅲ level and bleeding rate (P ＜0.01 ).Conclusions Low dose heparins and LMWHs are beneficial to controlling traumatic DIC,but the heparin therapy adjusted by the level of AT Ⅲ with marked correlation bleeding rate shows lower bleeding rate as compared with LMWHs.
