小剂量普通肝素治疗脓毒症的临床研究

Clinical study on low-dose unfractionated heparin therapy for sepsis

目的 探讨小剂量普通肝素对脓毒症的治疗作用.方法 将2007年10月至2009年12月入住我院ICU的85例脓毒症患者分为普通肝素治疗组45例和对照组40例.对照组给予早期应用广谱抗生素和容量复苏、控制血糖、抑酸保护胃黏膜、纠正水、电解质和酸碱平衡紊乱、脏器支持、基础病因治疗、营养支持及对症治疗.普通肝素治疗组在进行上述治疗的同时加用普通肝素5 U/（kg·h）,24 h持续静脉泵入,疗程为1周（或用至患者出现低凝状态或出血倾向,或用至患者出院或死亡）.比较2组患者治疗前后APACHEⅡ评分、CRP、凝血指标及血小板计数的变化;比较2组7 d及28 d转归及2组出血并发症发生率.结果 普通肝素治疗组28 d生存率为82.22%（37/45）,对照组为62.50%（25/40）,2组间差异有统计学意义（P＜0.05）.治疗后1周APACHEⅡ评分2组差异无统计学意义（P＞0.05）,但可以看出普通肝素治疗组的评分较对照组改善更大;普通肝素治疗组治疗前后比较,差异具有统计学意义（P＜0.05）;治疗后1周2组CRP差异无统计学意义（P＞0.05）,但2组治疗前后组内比较差异均有统计学意义（P＜0.01或P＜0.05）.2组治疗前后凝血功能的指标及血小板计数均差异无统计学意义（P＞0.05）;与对照组相比普通肝素治疗组未增加出血并发症的发生率.结论 小剂量普通肝素治疗能显著改善脓毒症患者的生存率,且无严重并发症,临床应用安全.

Objective To explore the therapeutic effects of low-dose unfractionated heparin（UFH） therapy on sepsis. Methods Eighty-five sepsis patients were divided into two groups： heparin treatment group （ n = 45 ）and routine treatment group （control group） （n =40）. The patients of control group received a series of remedies,including broad-spectrum antibiotics in early stage, supplementing of circulation volume, protecting of mucosal membrane of stomach, correcting the water, electrolyte and acid-base disturbance, and nutrition and supportive therapy. The patients of UFH treatment group were treated with UFH 5 U/（ kg · h） by continuous intravenous infusion for 7 days in addition to routine treatment. The difference of APACHE-Ⅱ score, CRP, coagulation markers and platelet count between two groups were analyzed before and after treatment. The hemorrhage complication and survival rate in 7 days and 28 days were compared between the two groups. Results The survival rate was 82.22% and 62.50% in UFH treatment group and control group respectively （P 〈 0.05）. There was no significant difference of coagulation markers and PLT count between the two groups before and after treatment （P 〉 0. 05）. The incidence of hemorrhage complication was not higher in UFH treatment group compared with that of control group （P 〉 0.05 ）.Conclusion UFH therapy can improve the survival rate of patients with sepsis.