血栓弹力图在指导脓毒症患者肝素应用中的意义

Significance of thromboelastography in guiding heparin use in patients with sepsis

目的探究血栓弹力图在脓毒症患者中肝素使用的指导意义。方法对48例符合脓毒症诊断标准患者的临床资料进行回顾性分析，随机分为对照组和观察组，两组患者入组时（0h）、人组后12h、24h、2d、3d、5d、7d查血小板及D-二聚体，对照组查血凝常规，观察组查血凝常规及血栓弹力图，同时给予脓毒症常规抗感染、补液等治疗，并予以肝素抗凝，比较两组患者肝素的使用时间、使用率及ICU住院时间、28d存活率及DIC发生率。结果观察组患者肝素的使用时间短于对照组（P〈0．05），肝素的总使用率无差异（P〉0．05），但24h肝素使用率明显高于对照组（P〈0．05）；观察组ICU住院时间明显短于对照组（P〈0．05），28d存活率高于对照组（P〈0．05），DIC发生率低于对照组（P〈0．05）。结论脓毒血症患者合并凝血功能紊乱，血栓弹力图可以早期判断高凝状态，并指导肝素应用，而及时、适量的肝素有利于减少脓毒症患者28d死亡率、DIC发生率及ICU住院时间。

Objective To investigate the significance of thrombelastography in guidance of heparin use in sepsis patients. Methods 48 in-patients with sepsis were randomly divided into 2 groups： control group （n-23） and experimental group （n=25）. The patients were treated with antibiotics based on the pathogen identified and rehydration treatment,and so on. They were also treated with heparin anticoagulation. Immediately after hospitalization, and 12 h, 24h, 2d, 3d, 5d, and 7d after after hospitalization samples of peripheral blood were collected to undergo platelet count, 2-dimer, and hemagglutination tests for both groups. However, the experimental group underwent thromboelastography （rrEG） in addition to the above mentioned examination items.The heparin use time and use rate, length of ICU stay, 28d survival rate , and disseminated intravaseular coagulation （DIC） incidence rate were compared. Results The 28d survival rate of the experimental group was 84.00%, significantly highrt than that of the control group（56.52%, P = 0.036）. The length of heparin use time of the experimental group was （5.32±0.98） days, significantly shorter than that of the control group [（7.21±1.56） days, P =0.01]. The DIC rate of the ecperimental goup was 12.00%, significantly lower than that of the control group （ 39.13%, P =0.03）. The 24h heparin use rate of the experimental group was 76.00%, significantly higher than that of the control group （47.83%, P =0.04）. Conclusion In sepsis patients combined with coagulation disorders, TEG helps judge the hypercoagulability, guide heparin administration reduce 28d mortality and incidence of disseminated intravascular coagulation, and shorten ICU staytime.