低分子肝素钙辅助连续性血液净化对重症脓毒血症患者凝血功能及血流动力学的影响

Effect of low molecular weight heparin calcium assisted continuous blood purification on coagulation function and hemodynamics in patients with severe sepsis

目的:探讨低分子肝素钙(LMWHC)辅助连续性血液净化(CBP)对重症脓毒血症患者凝血功能及血流动力学的影响。方法:选取2015年6月至2017年5月安徽省淮南市东方医院集团总院收治的重症脓毒血症患者84例,随机分为两组,每组42例。对照组采用普通肝素(HP)辅助CBP治疗,研究组采用LMWHC辅助CBP治疗。对比治疗前、后两组患者凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)和血小板(PLT)含量]、血流动力学参数[系统血管阻力指数(SVRI)、中心静脉血氧饱和度(ScvO_2)和平均动脉压(MAP)]及治疗期间不良事件发生率差异。结果:两组治疗前凝血功能指标和各血流动力学参数比较,差异均无统计学意义(均P>0.05);两组治疗后PLT、MAP和ScvO_2均显著高于治疗前(均P<0.05),PT、TT、APTT、Fbg和SVRI均显著低于治疗前(均P<0.05);且研究组PLT、MAP和ScvO_2均显著高于对照组(均P<0.05),PT、TT、APTT、Fbg和SVRI均显著低于对照组(均P<0.05)。研究组不良事件发生率显著低于对照组(P<0.05)。结论:LMWHC辅助CBP治疗重症脓毒血症效果明显,可显著改善患者凝血功能及血流动力学指标,有效降低不良事件发生率。

Objective：To explore the effect of low molecular weight heparin calcium（LMWH）assisted continuous blood purification（CBP）on coagulation function and hemodynamics in patients with severe sepsis.Methods：A total of 84 patients with severe sepsis in our hospital from June 2015 to May 2017 were selected and randomly divided into a study group and a control group,with 42 cases in each group.The patients in the control group were treated with heparin（HP）assisted CBP,while those in the study group were treated with LMWH assisted CBP.The coagulation function, hemodynamic parameters and the incidence of adverse events were observed and compared.Results：Before treatment,there were no significant differences in the prothrombin time（PT）,thrombin time（TT）,activated partial thrombin time（APTT）,levels of fibrinogen（Fbg）and platelet（PLT）,systemic vascular resistance index（SVRI）,saturation of central venous oxygen（ScvO2）,and mean arterial pressure（MAP）between the two groups（P〉0.05）.After treatment,the PLT,MAP and ScvO2 were notably increased,while the PT,TT,APTT,Fbg and SVRI were decreased（P〈0.05）.The changes were more significant in the study group（P〈0.05）.The incidence of adverse events was markedly lower in the study group than that in the control group（P〈0.05）.Conclusion：LMWH assisted CBP was effective in treating severe sepsis.This combination could improve coagulation function and hemodynamic indexes,and reduce the incidence of adverse events.