干预治疗对危重症患者凝血功能影响的临床研究  

Clinical research on coagulation function changes due to intervention treatment to critically ill patients.

作　　者：肖李乐云[1] 魏宏建[1] 朱晓琳[1] 任婵[1] 

机构地区：[1]昆明医学院第一附属医院ICU,云南昆明650032

出　　处：《云南医药》2008年第6期543-545,共3页Medicine and Pharmacy of Yunnan

摘　　要：目的旨在通过干预治疗对危重症患者凝血功能影响的临床研究,反思陈旧的认识,遏制滥用止血药物的行为,为临床合理应用止血药物提供科学依据。方法将40例入住ICU的APACHEII评分>12分,但尚未达到DIC诊断标准的凝血功能异常的危重症患者随机分为观察组和对照组。观察组给予血凝酶1KU/d静脉注射,氨甲苯酸0.4g/d静脉滴注共3d的干预治疗,对照组不使用上述药物治疗。2组患者均于入住ICU的第1d和第3d抽取外周血,动态监测血小板(PLT)、凝血酶原时间(PT)、国际标准化比值(INR)、凝血时间(TT)、纤维蛋白原(FIB)和活化部分凝血活酶时间(APTT)6项实验室指标。将观察组和对照组的6项实验室指标进行比较和统计学分析。结果1、将观察组和对照组入住ICU后第1d监测的凝血指标相比较,其P值均>0.05,说明两组患者分组随机,具有可比性。2、将观察组和对照组入住ICU后第3d监测的凝血指标相比较,其P值均>0.05,说明观察组和对照组经干预治疗和无干预治疗两种治疗方法无统计学意义。结论通过本临床研究,可指导临床医师在患者存在凝血功能异常但尚未达到DIC诊断标准时,即使是APACHEII评分>12分的危重症患者,也不必习惯性地"常规"给予止血药物,避免过度治疗,减少医药资源的浪费及过度干预治疗所带来的血栓栓塞性疾病等并发症。Objective Through the clinical research on coagulation function changes due to intervention treatment to critically ill patients,to provide the scientific basis for reasonable clinical application of hemostatic drugs. Methods To randomly divide 40 critically ill patients, whose coagunation function were abnormal in ICU with APACHEII score 〉 12, but not yet reached DIC diagnostic criterion, into treatment group and control group. The treatment group was given Haemocoagulase Atrox For Injection（1KU/d） via intravenous injection,and the Aminomethylenzoic Acid Injection（0.4g/d） via vein drop, totally three days＇ intervention treatments. The control group didn＇t use any above medications.Both two groups had peripheral blood drawn in first ICU day and third day. 6 laboratorial tests such as platelet, prothrombin time,international standardized ratio, thrombin time, fibrinogen and activatied partial thromboplastin time were performed.Statistic data between 2 groups were compared. Results 1st ICU day＇s statistic data between 2 groups had no significant differences（P 〉 0.05）. 3rd ICU day＇s data between 2 groups were as such too （P 〉 0.05）. It meant there was no any significant difference statistically whatever with or without intervention treatment.Conclusion Through this clinical research,it suggests physicians not to use hemostatic drugs regularly when patient＇s coagunation function doesn＇t reach DIC diagnostic criterion, even his APACHEII score 〉 12.

关 键 词：干预治疗 危重症患者 凝血功能 

分 类 号：R459.7[医药卫生—急诊医学]