微剂量肝素治疗恶性血液病并发弥散性血管内凝血28例疗效观察

Micro-Dose Heparin In the Treatment of 28 Cases Hematologic Malignancies with Dessiminated Intravas cular Coagulation

目的:探讨肝素治疗恶性血液病并发弥散性血管内凝血(DIC)合适的剂量。方法:对55例DIC患者,按原发病、DIC分期、分型随机分为观察组28例和对照组27例。观察组:用微剂量肝素15mg/d分三次静滴,对照组:急性型DIC和亚急性型DIC分别用小剂量肝素90mg/d和48mg/d分三次静滴;两组病例用肝素抗凝治疗3～7d,抗凝期间用凝血时间试管法(CT)进行监测。结果:观察组有效率60.7%(17/28例),其中急性型DIC有效率为60%(9/15例),明显高于对照组急性型DIC疗效(3/14例,有效率21.4%,p<0.05〕,应用微剂量肝素抗凝期间,CT保持在21～27min,无肝素引起的出血倾向加重等肝素副作用。对照组有效率44.4%(12/27例),在小剂量肝素抗凝期间,有5例CT时间达到32～34min并有出血倾向加重等肝素副作用。结论:微剂量肝素是治疗恶性血液病并发的DIC合适的抗凝剂量,对急性型DIC疗效明显高于小剂量肝素,安全性高,不加重出血倾向。

Objective: To explore the proper dose of heparin therapy in hematologic malignancies disease with dessiminated intravascular coagulation (DIC).Method: Fifty-five cases of DIC were divided randomly into two groups (The observed group and the control group)by the type and the period of DIC and primary affection. The micro –dose heparin group (The observed group,28 cases);heparin infusion in micro dose (15mg/d).The low-dose heparin group (The control group,27 cases):low dose heparin infusion (90mg/d in acute type of DIC and 48mg/d in subacute type of DIC).Heparin infusion 3～7d in all the cases and observe the clotting time by tube method during the heparin therapy. Result: The observed group 60.7%(17/28 cases)was effective in all the patients while 60%(9/15 cases) was effective in the acute type of DIC ,the effective rate was more higher in acute type of DIC than the control group (3/14 cases,effective rate was 21.4%,p<0.05) and the clotting time in 21～27 minutes with none haemorrhagic tendency by heparin therapy.The control group 44.4%(12/27 cases) was effective in all the patients,clotting time by tube method in 5 cases was delayed to 32～34 minutes and with haemorrhagic tendency during the heparin therapy .Conclusion: Heparin anti-coagulation.Therapy in hematologic malignancies with DIC,micro-dose of heparin is suitable for acute type of DIC,micro-dose heparin revealed a higher efficacy and safety in comparison with the low-dose heparin with less haemorrhagic tendency.