CAJ | 학술논문

目的：探讨小剂量肝素对脓毒症患者凝血功能的影响,观察小剂量肝素治疗脓毒症的临床效果。方法入选本院2011年7月-2013年10月间96例脓毒症患者,随机分为肝素组和常规组各48例,常规组采取容量复苏、纠正水和电解质紊乱、控制血糖、脏器支持等基础对症治疗,肝素组患者在常规组基础上持续静脉泵入普通肝素5 u/kg/h,疗程1周,评价小剂量肝素治疗脓毒症的临床效果。并检测两组患者PT、aPTT、PLT、TXB2、6-keto-PGF1α、CD62P、TXB2/6-keto-PGF1α( T/K)水平,计算两组患者急性生理与慢性健康评分( APACHEII),比较两组出血并发症与28日死亡率。结果治疗1 d、4 d、7 d后,两组患者PT、PLT、aPTT数值略有升降,两组比较无显著性差异(P>0.05)；肝素组患者TXB2、T/K、CD62P表达水平逐渐呈下降趋势,常规组患者则呈上升趋势,两组患者在7 d后TXB2、T/K、CD62P水平差异有统计学意义(P<0.05)；两组患者治疗后6-keto-PGF1α表达水平均呈上升趋势,肝素组治疗7 d后水平明显高于对照组(P<0.05)；两组治疗后APACHEII评分逐渐降低,肝素组患者治疗7 d后APACHEII评分(11.81±3.24)显著低于常规组(13.74±3.54)(P<0.05)。肝素组和常规组出血并发症发生率(12.50% vs.8.33%)差异无统计学意义(χ2=0.447,P=0.504)。两组患者28天病死率(18.75% vs.25.00%)(χ2=0.549,P=0.459)。结论脓毒症患者早期应用小剂量肝素可在不显著改变凝血时间的前提下,抑制脓毒症的凝血级联反应,纠正凝血功能紊乱,降低血小板活化水平,增强临床疗效,死亡率有下降倾向。
목적：탐토소제량간소대농독증환자응혈공능적영향,관찰소제량간소치료농독증적림상효과。방법입선본원2011년7월-2013년10월간96례농독증환자,수궤분위간소조화상규조각48례,상규조채취용량복소、규정수화전해질문란、공제혈당、장기지지등기출대증치료,간소조환자재상규조기출상지속정맥빙입보통간소5 u/kg/h,료정1주,평개소제량간소치료농독증적림상효과。병검측량조환자PT、aPTT、PLT、TXB2、6-keto-PGF1α、CD62P、TXB2/6-keto-PGF1α( T/K)수평,계산량조환자급성생리여만성건강평분( APACHEII),비교량조출혈병발증여28일사망솔。결과치료1 d、4 d、7 d후,량조환자PT、PLT、aPTT수치략유승강,량조비교무현저성차이(P>0.05)；간소조환자TXB2、T/K、CD62P표체수평축점정하강추세,상규조환자칙정상승추세,량조환자재7 d후TXB2、T/K、CD62P수평차이유통계학의의(P<0.05)；량조환자치료후6-keto-PGF1α표체수평균정상승추세,간소조치료7 d후수평명현고우대조조(P<0.05)；량조치료후APACHEII평분축점강저,간소조환자치료7 d후APACHEII평분(11.81±3.24)현저저우상규조(13.74±3.54)(P<0.05)。간소조화상규조출혈병발증발생솔(12.50% vs.8.33%)차이무통계학의의(χ2=0.447,P=0.504)。량조환자28천병사솔(18.75% vs.25.00%)(χ2=0.549,P=0.459)。결론농독증환자조기응용소제량간소가재불현저개변응혈시간적전제하,억제농독증적응혈급련반응,규정응혈공능문란,강저혈소판활화수평,증강림상료효,사망솔유하강경향。
Objective To explore influence low dose of heparin on blood coagulation function and platelet activation in patients with sepsis,and to observe its clinical efficacy for sepsis. Methods 96 patients with sepsis of Jul. 2011 to Oct. 2013 were enrolled and randomly divided into heparin group and conventional group,each group with 48 cases,conventional group was took capacity recovery,correction water and electro-lyte disorders,control blood sugar,viscera support,etc. and symptomatic treatment,based on which heparin group was intravenously pumped with heparin 5 u/kg/h continuously for 1 week,and PT,aPTT,PLT,TXB2 ,6-keto-PGF1α,CD62P,TXB2/6-keto-PGF1α(T/K)levels of 2 groups were collected after treatment for 1 d、4 d、7 d,besides,acute physiology and chronic health evaluation score( APACHEII) were calculated of 2 groups, and bleeding complications and 28 d mortality were compared. Results After treatment for 1 d,4 d,7 d,2 groups of patients with PT,PLT,aPTT varied slightly,and there were no significant difference between 2 goups (P> 0. 05). TXB2,T/K and CD62P level of heparin group gradually declined,whereas above indicators grad-ually increased,and there existed statistically significant differences after treatment for 7 d in TXB2 , T/K, CD62P(P<0. 05). 6-keto-PGF1 expression level increased in both 2 groups after treatment,6-keto-PGF1 level of heparin group after 7 d was significantly higher than control group(P<0. 05). APACHEII score of 2 groups after treatment decreased gradually,heparin group patients after 7 d whose APACHEII score(11. 81 ± 3 . 24 ) was significantly lower than conventional group ( 13 . 74 ± 3 . 54 ) ( P<0 . 05 ) . Heparin group and con-ventional group whose incidences of bleeding complications(12. 50% vs. 8. 33%)had no statistical difference (χ2 =0. 447P=0. 504). 2 groups of 28 day mortality(18. 75%vs. 25. 00%)(χ2 =0. 549,P=0. 459). Con-clusion Earlier application of low-dose heparin in auxiliary treatment of patients with sepsis can inhibit coag-ulation cascade,correct blood coagulation disorders,reduce platelet activation,and enhance clinical efficacy, show a lower mortality trend.