微量肝素治疗妊娠期急性脂肪肝合并DIC的临床意义

Therapeutic effect of micro-dose heparin on acute fatty liver in pregnancy with DIC

目的探讨微量肝素在妊娠期急性脂肪肝（AFLP）合并急性弥散性血管内凝血（DIC）的临床治疗价值。方法 21例确诊为AFLP合并DIC患者按是否运用微量肝素分为两组,微量肝素组13例,对照组8例。微量肝素组每天普通肝素用量为12~25mg,经微泵持续静脉输入,两组其他治疗原则相同,两组于治疗前及治疗后第5天检测凝血酶原时间（PT）、纤维蛋白原（FIB）、血小板计数（PLT）、D-D二聚体（D-Diner）,并计算DIC评分,观察两组ICU住院时间、28d病死率及DIC评分的改善情况。结果微量肝素组治疗后DIC评分较对照组显著改善（P=0.041）,ICU住院时间明显短于对照组（P=0.021）。结论微量肝素治疗有利于终止AFLP合并DIC的病理进程,改善器官血流灌注。

Objective To analyze the therapeutic effect of micro-dose heparin on acute fatty liver in pregnant patients who were in DIC stage. Methods Twenty-one pregnomt patients with severe acute fatty liver who were in DIC stage were randomly divided into micro-dose heparin intervention group （experimental group, 21 cases） and non-heparin-intervention group （control group,8 cases）. Subjects of both groups were treated according to the treatment guidelines for acute fatty liver of pregnancy. The experimental group was treated with heparin pumping （12-25 mg for 24 hours） continuously for 5 days. Blood was collected in both groups before and after the treatment of 5 days. Protrombin time（PT）, fibrinogen（FIG）, platelet count（PLT） and D-Diner were tested, DIC scores of patients were calculated, time of stay in ICU and 28-day case fatality were recorded. Results Compared to the control group, the DIC scores decreased on the fifth day （P=0.041） and the length of stay in ICU was shorter （P=0.021） in the experimental group. Conclusion Intervention of micro-dose heparin in the treatment of severe acute fatty liver of pregnant patients in DIC can terminate the pathological courses of acute fatty liver and improve the perfusion of organ.