小剂量肝素对脓毒症患者凝血功能及血小板活化的影响与临床疗效

Influence of low dose Heparin on Blood Coagulation Function and Platelet Activation in Patients with Sepsis and its Clinical Efficacy

目的探讨小剂量肝素对脓毒症患者凝血功能的影响,观察小剂量肝素治疗脓毒症的临床效果。方法入选本院2011年7月-2013年10月间96例脓毒症患者,随机分为肝素组和常规组各48例,常规组采取容量复苏、纠正水和电解质紊乱、控制血糖、脏器支持等基础对症治疗,肝素组患者在常规组基础上持续静脉泵入普通肝素5 u/kg/h,疗程1周,评价小剂量肝素治疗脓毒症的临床效果。并检测两组患者PT、a PTT、PLT、TXB2、6-keto-PGF1α、CD62P、TXB2/6-keto-PGF1α(T/K)水平,计算两组患者急性生理与慢性健康评分(APACHEII),比较两组出血并发症与28日死亡率。结果治疗1 d、4 d、7 d后,两组患者PT、PLT、a PTT数值略有升降,两组比较无显著性差异(P>0.05);肝素组患者TXB2、T/K、CD62P表达水平逐渐呈下降趋势,常规组患者则呈上升趋势,两组患者在7 d后TXB2、T/K、CD62P水平差异有统计学意义(P<0.05);两组患者治疗后6-keto-PGF1α表达水平均呈上升趋势,肝素组治疗7 d后水平明显高于对照组(P<0.05);两组治疗后APACHEII评分逐渐降低,肝素组患者治疗7 d后APACHEII评分(11.81±3.24)显著低于常规组(13.74±3.54)(P<0.05)。肝素组和常规组出血并发症发生率(12.50%vs.8.33%)差异无统计学意义(χ2=0.447,P=0.504)。两组患者28天病死率(18.75%vs.25.00%)(χ2=0.549,P=0.459)。结论脓毒症患者早期应用小剂量肝素可在不显著改变凝血时间的前提下,抑制脓毒症的凝血级联反应,纠正凝血功能紊乱,降低血小板活化水平,增强临床疗效,死亡率有下降倾向。

Objective To explore influence low dose of heparin on blood coagulation function and platelet activation in patients with sepsis,and to observe its clinical efficacy for sepsis. Methods 96 patients with sepsis of Jul. 2011 to Oct. 2013 were enrolled and randomly divided into heparin group and conventional group,each group with 48 cases,conventional group was took capacity recovery,correction water and electrolyte disorders,control blood sugar,viscera support,etc. and symptomatic treatment,based on which heparin group was intravenously pumped with heparin 5 u / kg / h continuously for 1 week,and PT,a PTT,PLT,TXB2,6-keto-PGF1α,CD62 P,TXB2/6-keto-PGF1α（ T/K） levels of 2 groups were collected after treatment for 1 d、4 d、7 d,besides,acute physiology and chronic health evaluation score（ APACHEII） were calculated of 2 groups,and bleeding complications and 28 d mortality were compared. Results After treatment for 1 d,4 d,7 d,2groups of patients with PT,PLT,a PTT varied slightly,and there were no significant difference between 2 goups（ P 〉 0. 05）. TXB2,T/K and CD62 P level of heparin group gradually declined,whereas above indicators gradually increased,and there existed statistically significant differences after treatment for 7 d in TXB2,T/K,CD62P（ P 〈 0. 05）. 6-keto-PGF1 expression level increased in both 2 groups after treatment,6-keto-PGF1 level of heparin group after 7 d was significantly higher than control group（ P 〈 0. 05）. APACHEII score of 2groups after treatment decreased gradually,heparin group patients after 7 d whose APACHEII score（ 11. 81 ±3. 24） was significantly lower than conventional group（ 13. 74 ± 3. 54）（ P 〈 0. 05）. Heparin group and conventional group whose incidences of bleeding complications（ 12. 50% vs. 8. 33%） had no statistical difference（ χ2= 0. 447 P = 0. 504）. 2 groups of 28 day mortality（ 18. 75% vs. 25. 00%）（ χ2= 0. 549,P = 0. 459）. Conclusion Earlier application of low-dose heparin in auxiliary treatment of patients with sepsis can inhibit coagulation cascade,correct blood coagulation disorders,reduce platelet activation,and enhance clinical efficacy,show a lower mortality trend.