小剂量肝素干预治疗对脓毒症前DIC期患者预后的影响

Effect of low-dose heparin on the sepsis patients in pre-DIC stage

目的探讨小剂量肝素干预治疗对脓毒症前DIC期患者的临床价值。方法37例脓毒症前DIC患者随机分为小剂量肝素干预组(观察组)22例和非肝素干预组(对照组)15例。两组均按脓毒症集束化治疗指南进行治疗;此外,观察组给予肝素(70U/kg)24h持续泵入5～7d,对照组用同等剂量的生理盐水持续泵入。治疗前及治疗后12、18、24、48、72h及7d采集两组静脉血并检测凝血酶原片段1、2(F1+2)、凝血酶抗凝血酶复合物(TAT),计算患者急性生理学及慢性健康状况评分(APACHE-Ⅱ评分),记录呼吸机使用天数、ICU住院时间及28d病死率。结果观察组第7天F1+2、TAT较对照组均显著降低(P=0.035,0.025);观察组呼吸机使用天数及ICU住院时间明显短于对照组(P=0.017,0.048);观察组治疗后APACHE-Ⅱ评分较对照组显著降低(P=0.044)。结论对脓毒症前DIC期患者早期给予小剂量肝素干预治疗可明显改善重症感染患者的高凝状态。

Objective To observe the effect of low-dose heparin on the sepsis patients who was in pre-DIC stage.Methods Thirty-seven patients with sepsis who was in the pre-DIC stage were randomly divided into low-dose heparin in the intervention group（experimental group,22 cases）and non-heparin-intervention group（control group,15 cases）.In addition,both of the two groups of subjects were treated according to the sepsis cluster treatment guidelines.The experimental group were pumped with heparin（70 U/kg for 24 hours）continously for 5 to 7 days,while the control group were pumped the same dose of normal saline.Blood was collected in the two groups before treatment and after the treatment for 12 hours,18 hours,24 hours,48 hours,72 hours,7 days.Thrombinogen fragment 1,2（F1＋2）,thrombin-antithrombine complex（TAT）were tested,APACHE-Ⅱscores of patients were calculated,and the use days of breathing machine,the length of stay in ICU and the 28-day case fatality were recorded.Results Compaired with the control group,F1＋2,TAT in the experimental group were decreased significantly on the seventh day（P=0.035,0.025）.The length of time of applying ventilator and the length of stay in ICU in the experimental group were shorter than that of the control group（P=0.017,0.048）.After the treatment,the scores in both groups decreased significantly compaired with the control group（P=0.044）.Conclusions Early intervention of low-dose heparin in the treatment of sepsis in the stage of pre-DIC can improve the hypercoagulable state.