小剂量低相对分子质量肝素治疗重度脓毒症伴播散性血管内凝血患者的护理

Study on Nursing of Patients with Severe Sepsis Complicated with Disseminated Intravascular Coagulation Treated by Low-dose Low Molecular Weight Heparin

目的探讨小剂量低相对分子质量肝素(LMWH)治疗重度脓毒症伴播散性血管内凝血(DIC)患者的护理配合。方法以2013年2月至2015年1月我院重症加强护理病房入住的60例重度脓毒症伴DIC患者为研究对象,随机分为观察组和对照组,对照组给予LMWH小剂量治疗及常规护理干预,观察组在对照组基础上另给予综合护理干预,观察治疗、护理干预后两组相关指标[出血停止时间、肝素使用时间、DIC指标恢复正常时间]、凝血指标[血浆凝血酶原时间(PT)、活化部分凝血活酶时间(a PTT)、血小板计数(PLT)]、治疗护理干预前后急性生理学与慢性健康状况评分(APACHE II评分)及治疗护理干预后病死率比较情况。结果治疗、护理干预后观察组较对照组出血停止时间(1.43±0.31)d、肝素使用时间(4.13±1.31)d、术中引流量DIC指标恢复正常时间(3.98±0.50)d分别均显著短(P<0.05);治疗、护理干预后两组PT、a PTT分别均显著降低,PLT显著升高,APACHE II评分分别均显著减小;且观察组较对照组PT(16.12±2.48)s、a PTT(27.26±0.61)s分别均降低显著,治疗护理后1 d、7 d、14 d,APACHEII评分(20.81±4.49)分、(15.62±3.89)分、(9.13±2.38)分分别均减小显著,PLT(98.82±28.98)×109/L升高显著,均具有统计学意义(P<0.05)。结论护理配合低分子肝素小剂量治疗对重度脓毒症伴DIC患者病情控制作用显著,提高临床治疗效果。

Objective To explore the nursing cooperation of patients with severe sepsis complicated with disseminated intravascular coagulation( DIC) treated by low-dose low molecular weight heparin( LMWH).Methods 60 cases of patients with severe sepsis complicated with DIC who were hospitalized in ICU( intensive care unit) of our hospital between February 2013 and January 2015 were selected as the study objects. The subjects were equally divided into observation group and control group by the random number table method. The control group was treated with low- dose LMWH and was given routine nursing intervention.,the observation group was additionally given comprehensive nursing intervention. The related indexes( bleeding stop time,use time of heparin,time of DIC index returning to normal level),coagulation indexes[plasma prothrombin time( PT),activated partial thromboplastin time( a PTT),platelet count( PLT) ],acute physiology and chronic health evaluation( APACHE II score) and mortality rates in the two groups were observed before and after treatment and nursing intervention. Results After treatment and nursing intervention,the bleeding stop time[( 1. 43 ± 0. 31) d],use time of heparin[( 4. 13 ± 1. 31) d],intraoperative drainage volume and time of DIC indexes recovering to normal level [( 3. 98 ± 0. 50) d]in the observation group were significantly shorter than those in the control group( P < 0. 05); After treatment and nursing intervention,PT and a PTT in the two groups decreased significantly while PLT increased significantly and APACHE II scores decreased significantly; Besides,PT[( 16. 12 ± 2. 48) s]and a PTT[( 27. 26 ± 0. 61) s]of the observation group were significantly shorter than those of the control group. 1 day,7 days and 14 days after treatment and nursing intervention,APACHE II scores[( 20. 81 ± 4. 49),( 15. 62 ± 3. 89),( 9. 13 ± 2. 38) ]decreased significantly while PLT[( 98. 82 ± 28. 98) × 10~9/ L]increased significantly( P < 0. 05). Conclusion The application of nursing combined with LMWH can effectively control the pathogenetic condition of patients with severe sepsis complicated with DIC and improve the clinical treatment effect.