小剂量肝素微量泵持续定时静脉注射治疗小儿原发性肾病综合征的临床研究  

Low-dose heparin micro-pump continuous regular infusion in the treatment of primary nephrotic syn- drome

作　　者：洪建东[1] 付清流[1] 郑天文[1] 苏志强[1] 习战榕[1] 

机构地区：[1]福建泉州市儿童医院,362000

出　　处：《中国小儿急救医学》2010年第5期404-406,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨小剂量肝素微量泵持续定时静脉注射对小儿原发性肾病综合征（PNS）的疗效及安全性。方法对PNS合并高凝状态88例患儿采取开放性对照研究的方法进行临床研究。肝素治疗组在常规应用糖皮质激素治疗的基础上加用小剂量肝素微量泵持续定时静脉注射治疗，并与常规糖皮质激素组进行对照。结果肝素治疗组治疗后血清白蛋白、APIT均高于治疗前，差异有显著性（P〈0．01），而血Fib低于治疗前，差异有显著性（P〈0．01）。常规治疗组治疗后血清白蛋白高于治疗前，差异有显著性（P〈0．01），而血APIT、血Fib与治疗前比较差异均无显著性（P〉0．05）。肝素治疗组治疗后血清白蛋白、APTT均高于常规治疗组，差异有显著性（P〈0．01），而血Fib低于常规治疗组，差异有显著性（P〈0．01）。肝素治疗组治疗后尿蛋白转阴率82／88例（93．2％），高于常规治疗组[63／80例（78．8％）]，差异有显著性（P〈0．01）。尿蛋白转阴病例中，肝素治疗组尿蛋白转阴时间、水肿消退时间均短于常规治疗组，差异有显著性（P〈0．01）。肝素浓度为峰值时，肝素治疗组血APIT（61．72±10．23）s，高于治疗前的血删[（25．92±9．54）s]，差异有显著性（P〈0．01），且两者均数比值为2．38；肝素浓度为谷值时，血APTT（28．08±7．69）s，与治疗前比较差异无显著性（P〉0．05）。结论小剂量肝素微量泵持续定时静脉注射治疗小儿PNS的抗凝作用明显，能提高尿蛋白转阴率，且能缩短尿蛋白转阴及水肿消退时间；同时该疗法安全，不需要实验室监测，药物不良反应少，值得临床推广。Objective To explore the efficacy and safety of low-dose heparin in the treatment of children with primary nephrotic syndrome （PNS）. Methods It was an open and comparative trial. Eighty- eight children with PNS in the hypercoagulable state,on the basis of administrating with glucocorticosteroid, were administrated with low-dose heparin that infused by micro pump oriented to time （ group A）. Eighty pa- tients only treated with glucocorticosteroid were chosen as control （ group B）. Results Serum-albumin and activated partial thromboplasfin time （APTT） increased,but fibrinogen （Fib） decreased after therapy in the group A,and they all showed significant differences （P 〈 0.01 ）. Serum-albumin increased after therapy in the group B and there was significant difference （P 〈0. 01 ）. However,APTT and Fib in the group B showed no significant difference （ P 〉 0. 05 ） between post-treatment and pretherapy. Post-treatment serum-albumin and APTT in the group A were significantly higher than those in group B, and Fib was significantly lower than that in group B （P〈0. 01 ）. The rate of urine protein remission in group A （82/88） was significantly higher than that in group B （63/80）. Urine protein remission time and edema disappearance time were significantly shorter in group A than group B （ P 〈 0. 01 ）. APTT of group A at the peak concentration of heparin after therapy was significantly higher than that of pretherapy （P 〈0. 01 ） ,and the ratio was 2. 38. However,there was no significant difference in APTT at the valley concentration of heparin between post-treatment and pretherapy（ P 〉 0. 05）. Conclusion Low dose-heparin infused by micro pump oriented to time in the treatment of children with PNS has an obvious anticoagutative effect. It can improve the rate of urine protein remission and shorten edema disappearance time. Meanwhile it is safety, requires no laboratory monitor and has few drug side effects,thus it deserves further clinical application.

关 键 词：小剂量肝素 肾病综合征 原发性 高凝状态 儿童 

分 类 号：R726[医药卫生—儿科]