低分子肝素改善脓毒症凝血功能临床疗效观察

Clinical efficacy studies of low-molecular-weight heparin in the treatment for sepsis

目的评价低分子肝素对脓毒症患儿凝血功能改善的疗效。方法将2007年1月至2008年1月首都儿研所附属儿童医院ICU诊断的脓毒症患儿24例,随机分为低分子肝素治疗组和对照组各12例。监测两组患儿的血小板(PLT)计数、凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、纤维蛋白原(Fbg)、D-二聚体(D-dimer)、纤维蛋白降解产物(FDP)和凝血酶-抗凝血酶复合物(TAT)、蛋白C(PC)、蛋白S(PS)和抗凝血酶-Ⅲ(AT-Ⅲ),并进行危重程度评分。结果脓毒症患儿治疗后的PC、PS均较治疗前升高,肝素治疗组和对照组比较差异有统计学意义(P<0.01);两组患儿治疗后TAT较治疗前均明显下降,治疗组下降幅度大于对照组,但差异无统计学意义(P>0.05);治疗2d,两组患儿危重评分均有升高,治疗组升高较对照组明显,差异有统计学意义(P<0.05)。结论低分子肝素治疗可有效改善脓毒症患儿的出凝血功能紊乱,小剂量应用无明显出血的副反应。

Objective To evaluate the efficacy of low molecular weight heparin in patients with sepsis. Methods A total of 24 patients with sepsis were randomly divided into LMWH treatment group and control group. Both groups were examined TAT, AT- Ⅲ , PC, PS, PLT, PT, APTT, Fbg, D-d, FDP and severity score. Results PC and PS in these two groups were increased after treatments, and those of LMWH treatment group were increased more significantly than those of control group; there was a significant difference between these two groups （P 〈 0.001 ）. TAT in these two groups fell after treatments, and that of LMWH treatment group fell more significantly than that of control group, but there was no statistic difference between these two groups （P 〉 0.05）. Severity score in these two groups was increased after 2 days＇ treatment; severity score in LMWH treatment group was increased more significantly than that of control; there was a significant difference between these two groups （P 〈 0.05）. Conclusion Low dosage of low molecular weight heparin treatment in patients with sepsis is effective on improving function of hemorrhagic-coagulation and the clinical condition without complications of bleeding.