低分子肝素治疗严重脓毒症合并急性肾衰竭的临床疗效

Curative efficacy of low molecular weight heparin in the treatment of severe sepsis complicated with acute renal failure

目的探讨低分子肝素治疗严重脓毒症合并急性肾衰竭患者的临床疗效。方法回顾性分析2014-12至2016-12在新疆石河子大学医学院第一附属医院诊治的62例严重脓毒症合并急性肾衰竭患者的临床资料。采用常规治疗,如呼吸支持、抗感染、维持电解质和水平衡等的患者为对照组(n=31);在常规治疗基础上给予低分子肝素钙治疗的患者为观察组(n=31)。比较两组的胱抑素C(cystatin C,CysC)、血清肌酐(serum creatinine,Scr)及尿素氮(blood urea nitrogen,BUN)等相关肾功能指标的变化,以及D-二聚体、血小板、纤维蛋白原(fibrinogen,FIB)、凝血酶原时间(prothrombin time,PT)等相关凝血功能指标的变化,并比较两组的生存率。结果 (1)治疗后,两组肾功能指标CysC、Scr、BUN均得到明显改善,与治疗前比较,差异均具有统计学意义(P<0.05);且观察组的肾功能指标CysC、Scr、BUN改善情况均优于对照组,差异均具有统计学意义(t=3.609,13.944,7.072;P<0.05)。(2)治疗后,两组的凝血功能指标D-二聚体、血小板、FIB、PT发生明显改善,与治疗前比较,差异均具有统计学意义(P<0.05);且观察组凝血功能指标D-二聚体、血小板、FIB、PT改善情况均明显优于对照组,差异均具有统计学意义(t=-14.565,-4.135,-7.278,2.544;P<0.05)。结论低分子肝素可抑制促炎性细胞因子的活性,改善血流动力学和抑制血栓形成,进而明显改善脓毒症合并急性肾衰竭患者的肾功能和凝血功能。

Objective This study aimed to investigate the clinical efficacy of low molecular weight heparin in the treatment of severe sepsis complicated with acute renal failure. Methods The clinical data of 62 severe sepsis patients complicated with acute renal failure that presented to the First Affiliated Hospital of the Medical College of Shihezi University from December 2014 to December 2016 were analyzed retrospectively. Conventional therapy such as respiratory support, antibiotics and maintaining fluid and electrolyte balance was provided to the control group （n=31）; in addition to conventional therapy, low molecular weight heparin was administered to the patients of the observation group （n=31）. The parameters of renal function including the changes of cystokine C （CysC）, serum creatinine （Scr） and blood urea nitrogen （BUN） and the parameters of coagulative function including D-dimer, platelet, Fibrinogen （FIB）, prothrombin time （PT） as well as the survival rate were compared between the two groups. Results （1） Following treatment, the renal function parameters of CysC, Scr and BUN of both groups were significantly improved as compared with those before treatment （P〈0.05）; the renal function parameters of CysC, Scr and BUN in the observation group were superior to those of the control group （t=3.609, 13.944, 7.072;P〈0.05）. （2） After treatment, the coagulative function parameters of D-Dimer, platelet, FIB and PT were significantly improved as compared with those before treatment （P〈0.05）; the coagulation function parameters of D-Dimer, PLT, FIB and PT in the observation group were superior to those in the control group （t=-14.565,-4.135,-7.278,2.544;P〈0.05）. Conclusions Low molecular weight heparin can inhibit pro-inflammatory cytokine activity, improve hemodynamics and inhibit thrombosis, and further enhance the renal and coagulation function of patients with sepsis complicated with acute renal failure.