小剂量肝素钠与低分子肝素钙对脓毒症治疗作用的对比研究

Clinical effects comparison of low dose heparin and low molecular weight heparin on sepsis

目的观察小剂量肝素钠与低分子肝素钙对脓毒症的治疗效果差异。方法将90例脓毒症患者随机分为A、B、C三组,A组给予常规治疗包括早期广谱抗生素,液体复苏等,B组常规治疗基础上持续给予小剂量肝素5~10U/（kg·h）静脉泵入,C组在常规治疗基础上加低分子肝素钙0.6 ml皮下注射。对比三组患者治疗前及治疗后第1、3、5、7 d急性生理学慢性健康状况Ⅱ（APACHEⅡ）评分,治疗前和治疗后的凝血指标、炎症因子指标、播散性血管内凝血（DIC）发生率、28 d病死率和不良反应发生率。结果 B、C两组患者治疗后各时点APACHEⅡ显著低于A组（P〈0.05）,C组患者治疗5 d后APACHEⅡ分值显著低于B组（P〈0.05）。B、C两组患者治疗后血小板（PLT）、纤维蛋白原（Fib）、凝血活酶时间（APTT）,凝血酶原时间（PT）水平显著优于A组（P〈0.01）,C组患者各指标显著优于B组（P〈0.05）。B、C两组患者治疗后血清肿瘤坏死因子（TNF-α）、白细胞介素-6（IL-6）、C反应蛋白（CRP）水平显著低于A组（P〈0.05）,C组患者TNF-α水平显著低于B组（P〈0.05）。B、C两组患者DIC发生率、28 d病死率显著低于A组（P〈0.01,P〈0.05）,C组患者DIC发生率显著低于B组（P〈0.05）。结论低分子肝素钙对脓毒症的治疗更为有效,可以有效改善患者的凝血功能及炎症水平,具有临床应用价值。

Objective To study the clinical effects difference of low dose heparin and low molecular weight heparin on sepsis. Methods A total of 90 sepsis patients were randomly divided into A,B,C three group,30 patients in each group. Patients in group A were treated by routine therapy including antibiotic treatment and fluid resuscitation. Patients in group B were treated by routine therapy and heparin 5 ~ 10 U / kg·h intravenous infusion. Patients in group C were treated by routine therapy and low molecular weight heparin 0. 6m L subcutaneous. The APACHE Ⅱ scores were compared between three groups before and on d1,d 3,d 5,and d 7 after treatment. The coagulation index,inflammation factor index,DIC rate and death rate in 28 d were compared. Results The APACHE Ⅱ score in group B and group C was significantly less than that in group A at different time after treatment（ P〈0. 05）. After treatment,APACHE Ⅱ score in group C was significantly less than that in group B on d 5（ P〈0. 05）. The PLT,Fib,APTT and PT levels in group B and group C were significantly better than those in group A（ P〈0. 01）. And those indexes in group C were significantly better than those in group B（ P〈0. 05）. The serum TNF- α,IL- 6,CRP levels in group B and group C were significantly lower than those in group A（ P〈0. 05）. And TNF- α level in group C was significantly lower than that in group B,after treatment（ P〈0. 05）. The DIC rate and death rate in group B and group C were significantly lower than those in group A（ P〈0. 05）. The DIC rate in group C was significantly lower than that in group B（ P〈0. 05）. Conclusion Low molecular weight heparin has a better clinical effects on sepsis which can improve coagulation and inflammation makes it worth for clinical application.