小剂量肝素对危重新生儿伴全身炎症反应综合征的早期干预作用

The intervention of systemic inflammatory response syndrome at early stage in newborn infants with low-dose heparin

目的观察小剂量肝素对危重新生儿全身炎症反应综合征(SIRS)的治疗效果及预后的影响。方法对我科2005年6月至2007年6月间符合诊断标准的94例新生儿SIRS患儿随机分组进行前瞻性对照研究,对照组46例采用常规治疗,治疗组48例在常规治疗基础上每次加用小剂量肝素(5u/kg)皮下注射,每6h 1次,连用3d,观察两组C-反应蛋白(CRP)、血小板计数(PLT)、D-二聚体(D-D)治疗前后的变化。结果治疗组SIRS持续时间>3d者16例(33.3%),明显少于对照组的28例(60.9%),MODS发生率和病死率也明显低于对照组(10.4%、4.2%vs34.8%、17.4%)(P<0.01或0.05);两组治疗后的PLT、CRP及D-D水平均明显改善,且以治疗组更为明显(P<0.01)。治疗组使用肝素后凝血指标均恢复正常或趋于正常。结论早期应用小剂量肝素可有效缩短SIRS持续时间,MODS的发生率及病死率明显降低。

Objective To observe the intervention of systemic inflammatory response syndrome （SIRS） at early stage in newborn infants with low-dose heparin. Methods Ninety-four newborn infants diagnosed as SIRS registered in the department ward from June 2005 to June 2007 were selected and randomly divided into two groups, the control group with 46 cases receiving the routine treatment, and the treatment group with 48 cases receiving the routine treatment plus a low-dose heparin （SU·kg^-1 , q6h for 3 days） via subcutaneous injection. The C-reactive protein （CRP）, platelet number （PLT） and D-dimer （D-D） were ob- served before and after the treatment, and the changes of the variables above between the two groups were compared. Results There were 16 cases （33.3%） with SIRS lasting for 3 days more in the treatment group, significantly lower than 28 cases （60. 9 % ） in the control group, P 〈 0.01. The mortality and incidence of multi-organ dysfunction syndrome （MODS） were significantly lower in the treatment group （ 10.4 % and 4.2 % ） than in the control group （34.8 96 and 17.4 % ）, P 〈 0.01 or 0.05, respectively. The variables PLT, CRP and D-D were improved after the treatment, with more in the treatment group than in the con- trol group, P〈0.01. The coagulation index recovered or approached to the normal levels in the treatment group after the use of heparin. Conclusion Early use of the low-does heparin in SIRS treatment could effectively shorten its duration and decreased the mortality and incidence of MODS.