小剂量未分馏肝素对严重脓毒症防治作用的临床观察

Clinical observation of unfractioned heparin for preventive and therapeutic effects on severe sepsis

目的评价小剂量未分馏肝素对严重脓毒症的防治作用。方法严重脓毒症患者52例,随机分为肝素组(27例)和对照组(25例),肝素组在标准治疗基础上加用未分馏肝素持续静脉滴注5天,对照组则采用标准治疗加等量生理盐水。对干预前及干预后第3天、第5天的临床表现、实验室指标进行比较观察。结果两组间APACHE-Ⅱ评分、血小板计数(BPC)、3T试验、纤维蛋白原(FDP)水平、弥散性血管内凝血(DIC)发生率和28天死亡率无显著性差异;两组病人D-二聚体(D-Dimer)水平均随时间延长呈现下降趋势,肝素组5天后D-Dimer水平的下降程度与对照组相比存在差异(P<0.05)。结论小剂量未分馏肝素持续静脉滴注对化解严重脓毒症病人的高凝状态具有辅助治疗作用。

Objective To evaluate preventive and therapeutic effects of low dose of unfmctioned heparin on severe sepsis. Methods 52 Patients with severe sepsis hospitalized in Intensive Care Units were randomly divided into control group and heparin group. On the ba sis of conventional therapy, patients with sepsis were given low dose of unfractioned heparin or isovolume physiologic saline by continuous intravenous drip infusion over 5 days. Acute Physiologic and Chronic Healthy Evaluation （APACHE-I]） score, blood platelet count（BPC）, prothrombin time（PT）, activated partial thromboplastin time（aPTT）, thrombin time（TT）, plasma fibrinogen（FDP） and D-dimer levels were assessed on admission, 3rd, 5th day after intervention. Incidence of disseminated intravascular coagulation（DIC） and 28-day mortality between heparin group and control group were compared. Resldts There were no significant difference in APACHE-Ⅱ, BPC, PT, aPTT, TT, and FDP levels, incidence of DIC, and 28-day mortality between heparin group and control group. D-dimer levels in both groups decreased along with time. D-dimer levels on 5th day after treatment in heparin group was markedly decreased than that of control group（740 -135μg/L vs 853±179μg/L, P〈0. 05）. Conclusions There could be adjunctive therapy for low dose of unfractioned heparin by continuous drip infusion was an effective adjunctive therapy to attenuate hypercoagulability in patients with severe sepsis. In order to improve preventive and therapeutic methods to decrease mortality in patients with sepsis, further study on mechanism of sepsis should be taken.