R值与APTT监测指导下对肿瘤合并脓毒症凝血功能障碍患者行抗凝治疗的效果比较

Comparison of the effects of anticoagulant therapy in patients with tumor complicated with sepsis and coagulation dysfunction under the guidance of R value and APTT monitoring

目的探讨R值与活化部分凝血活酶时间(APTT)监测指导下对肿瘤合并脓毒症凝血功能障碍患者行抗凝治疗的有效性及安全性。方法选择2019年1月至2022年1月收治的80例肿瘤合并脓毒症凝血功能障碍患者作为研究对象,以随机数字表法将其分为A组与B组,每组40例。A组在R值指导下行抗凝治疗,B组在APTT指导下行抗凝治疗。比较两组的治疗效果及安全性。结果两组的机械通气时间无明显差异(P>0.05);A组的ICU住院时间、凝血四项指标恢复正常时间均短于B组,肝素使用剂量低于B组(P<0.05)。治疗5 d时,两组的C反应蛋白(CRP)、细胞黏附分子-1(ICAM-1)水平均明显降低,胆碱酯酶(CHE)水平升高,且A组优于B组(P<0.05)。两组治疗期间的不良事件发生率无明显差异(P>0.05)。结论R值与APTT监测指导下对肿瘤合并脓毒症凝血功能障碍患者行抗凝治疗均能获得满意效果且有着较高安全性,但R值监测指导下行抗凝治疗能够缩短凝血四项指标恢复正常时间,降低肝素使用剂量,也能快速恢复CRP、ICAM-1、CHE水平,可作为首选监测指标。

Objective To investigate the efficacy and safety of anticoagulant therapy in patients with tumor complicated with sepsis and coagulation dysfunction under the guidance of R value and activated partial thromboplastin time(APTT)monitoring.Methods A total of 80 patients with tumor complicated with sepsis and coagulation dysfunction admitted from January 2019 to January 2022 were selected as the research objects and divided into group A and group B by random number table method,with 40 cases in each group.The group A was received anticoagulation therapy under the guidance of R value,and the group B was received anticoagulation therapy under the guidance of APTT.The therapeutic effect and safety of the two groups were compared.Results There was no significant difference in mechanical ventilation time between the two groups(P>0.05);the ICU hospitalization time and the recovery normal time of four coagulation indexes in the group A were shorter than those in the group B,and the dosage of heparin was lower than that in the group B(P<0.05).After treatment for 5 d,the levels of C-reactive protein(CRP)and intercellular adhesion moleclar-1(ICAM-1)in the two groups significantly decreased,and the level of cholinesterase(CHE)increased,and those in the group A were better than the group B(P<0.05).There was no significant difference in the incidence of adverse events between the two groups during treatment(P>0.05).Conclusion Anticoagulant therapy under the guidance of R value and APTT monitoring have satisfactory effect and high safety in patients with tumor complicated with sepsis and coagulation dysfunction.However,anticoagulant therapy under the guidance of R value monitoring can shorten the recovery normal time of four coagulation indexes,reduce the dosage of heparin,and quickly restore the levels of CRP,ICAM-1 and CHE,which can be used as the preferred monitoring index.