床边实时超声检查对指导脓毒症患者抗凝治疗的临床意义

Clinical significance of bedside real-time ultrasound examination for guidance of anticoagulation in patients with sepsis

目的探讨床边实时超声在重症监护病房(ICU)脓毒症患者抗凝治疗过程中的指导意义,为降低抗凝风险提供临床依据。方法收集ICU病房中脓毒症患者212例,根据修订Geneva量表评分系统,将患者分为低危、中危和高危。90例低危患者中,未进行抗凝治疗30例(A组),随机抗凝治疗30例(B组),经超声指导下抗凝30例(C组),比较3组患者血小板减少和出血发生率、机械通气使用天数、患者病死率等。结果 3组患者病死率差异无统计学意义(P>0.05),但B组造成的临床出血风险最高,与A组和C组比较,临床发生消化道、气道或泌尿道出血例数增加,且差异有统计学意义(P<0.05)。治疗前,3组病例血小板差异无统计学意义(P>0.05),但经抗凝治疗后,B组造成的血小板下降最为明显,与A组和C组比较,差异有统计学意义(P<0.05),对于患者机械通气使用天数,以超声引导下抗凝组时间最短。结论超声引导下抗凝治疗,可明显降低ICU脓毒症患者机械通气天数,减少患者出血风险,但对于脓毒症患者病死率无明显影响。

Objective To investigate the guidance significance of bedside real-time ultrasound examination in the anticoagulant ther-apy on ICU patients with sepsis so as to provide a clinical reference for decreasing anticoagulant risks. Methods A total of 212 ICU patients with sepsis were collected and classified into low risk, medium and high risk patients according to revised Geneva rating scale scoring system. In 90 low risk patients, 30 patients did not undergo anticoagulant therapy （group A）, 30 patients received random anticoagulant therapy （ group B） and 30 patients underwent ultrasound-assisted anticoagulant therapy （ group C） . For three groups （ A, B and C） , thrombocytope-nia and hemorrhage incidence rate, days of mechanical ventilation use and fatality rate were compared. Results No statistical significance was indicated in the difference of fatality rate of three groups（P〉0. 05）, but highest clinical hemorrhage risk was found in group compared with group A and group C. The cases of hemorrhage in digestive tract, airway or urinary tract were increased, and the difference had statisti-cal significance（P〈0. 05）. Before the treatment, no statistical significance was showed in the difference of platelets of three groups, but group B indicated the most significant thrombocytopenia after anticoagulant therapy compared with group A and B, and the difference demon-strated statistical significance（P〈0. 05）. As for the days of mechanical ventilation use, the time of group C was the shortest. Conclusion The ultrasound-assisted anticoagulant therapy can significantly shorten the days of anticoagulant therapy use in ICU patients with sepsis and lower hemorrhage risks, but generate no significant influence on fatality rate of patients with sepsis.