小剂量肝素在全身炎症反应综合征的危重病人中的应用  

Safety of small-dose heparin subcutaneous injection for critically Ill patients with systemic inflammatory response syndrome

作　　者：刘美描[1] 余雪涛 方伟强[1] 吴丽英 

机构地区：[1]汕大医学院第一附属医院ICU,广东汕头515041

出　　处：《国际医药卫生导报》2008年第4期56-60,共5页International Medicine and Health Guidance News

摘　　要：目的探讨小剂量肝素在全身炎症反应综合症的危重病人中应用的安全性。方法入住本院ICU的各种危重病人，如出现全身炎症反应综合征且血小板数不低于20×10^9／L者，给予皮下注射小剂量肝素，监测其血小板、出凝血功能、肝肾功能、伤口渗血及伤口引流管引流液情况。结果共有48例出现全身炎症反应综合征的危重病人使用皮下注射小剂量肝素，（12．5～75）mg／d，平均（47．66±10．83）mg／d，使用（4～20）天，平均（8．73±3．91）天。治疗前PT、PT活性、血小板数、D-二聚体、纤维蛋白原均有不同程度的异常。肝素治疗前后纤维蛋白原无明显变化（P=0．87），伤口、针眼等均无渗血；治疗后PT、PT活性、D二聚体、血小板数较治疗前明显好转（P值分别为0．02、〈0．001、0．043和〈0．001）。结论皮下注射小剂量肝素在全身炎症反应综合征的危重病人中应用是安全的，对于改善这类病人凝血功能可能有益处。Objective To evaluate the safety of small-dose heparin by subcutaneous use of the treatment for critically ill patients with systemic inflammatory response syndrome （SIRS） Methods All kinds of critically ill patients with SIRS and platelet （ PLT ） count not less than 20×10^9/L were enrolled in this study and then gave them small dose heparin by subcutaneous injection. PLT, hemostatic function, liver-renal function and bleeding from wound and so on were surveyed closely. Results 48 critically ill patients with SIRS received small dose heparin by subcutaneous injection. The dose of heparin was from 12.5mg to 75mg per day, Average（47.66± 10.83） mg/d, and the duration was from 4 days to 20 days, Average（8. 73 ±3.91） days. Prothromin time （PT）, PT activity （PTA）, D-dimer （D-D）, PLT and fibrigen （Fbg） were all abnormal in deferent degree before heparin treatment. Otherwise, they improved significantly after treatment （P values were 0.02, 〈0. 001, 0.043 and 〈0.001 respectively） except for Fbg （P value 0.87）. At the same time, no active bleeding were found in wounds and injection sides. Conclusion It＇s safe to administrate small dose heparin by subcutaneous route of the therapy for critically ill patients with SIRS. And it may play some good effects to their hemostatic function.

关 键 词：小剂量肝素 皮下注射 危重病人 安全性 

分 类 号：R45[医药卫生—治疗学]