小剂量肝素治疗脓毒症30例临床分析  

The efficacy of low molecular weight heparin in the treatment of sepsis:a report of 30 clinical cases

作　　者：林勇军[1] 熊滨[1] 

机构地区：[1]广西壮族自治区人民医院,广西南宁530021

出　　处：《右江民族医学院学报》2011年第1期3-5,共3页Journal of Youjiang Medical University for Nationalities

基　　金：广西自然科学基金(桂科自0542064)

摘　　要：目的观察低分子肝素对脓毒症患者的治疗效果。方法 52例脓毒症患者随机分为对照组(22例)和低分子肝素组(以下简称治疗组,30例)。观察两组患者治疗前后急性生理学慢性健康状况Ⅱ(APACHEⅡ)评分、肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、乳酸、D-二聚体、凝血酶原时间(PT)、凝血活酶时间(APTT)、纤维蛋白原(FDP)、血小板计数(PLT)、弥散性血管内凝血(DIC)发生率和28天病死率差异。结果 APACHEⅡ评分、TNF-α、IL-6、乳酸随着时间延长均呈下降趋势,其中,治疗组TNF-α、IL-6、乳酸下降更为明显(P<0.05);两组治疗前后PT、APTT、FDP、PLT差异无显著性(P>0.05);治疗组D-二聚体明显下降,治疗后第3天、第7天与对照组比较,差异有显著性(P<0.05);两组患者DIC发病率及28天病死率差异无显著性(P>0.05)。结论低分子肝素可以改善脓毒症患者全身炎症反应状态和血液高凝状态,具有一定的临床应用价值,但仍需进一步临床研究观察。Objective To evaluate the efficacy of low molecular weight heparin （LMWH） on patients with sepsis. Methods 52 patients with sepsis were randomized divided into two groups, the LMWH group, ie, the therapeutic group, n =30 cases; the control group, n =22 cases. Before and after treatment, the scores of Acute Physfology And Chronic Health Evaluation Ⅱ （APACHE Ⅱ ）, tumor necosis faetoralpha （TNF- α）, interleukin - 6 （IL- 6）, lactic acid level, D- dimer level （D- D）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen degradation product （FDP）, platelet count （PLT）, the incidence of disseminated intravascular coagulatiomn （DIC） and the incidence of 28 - days mortality were recorded. Results In the two groups, the A- PACHE II scores, TNF-α, IL-6, and the lactic acid level decreased with time prolonged. Of which, in the thera- peutic group, TNF-α, IL-6, and the lactic acid level decreased moie significantly before treatment （ P 〈 0.05）. Before and after treatment compared among the two groups, the levels of PT, APTT, FDP, PLT differed not significantly （ P 〉0.05）. And in the therapeutic group, Ddimer level decreased significantly, and compared to those in the third and the seventh days in the control groups, the difference differed significantly （ P 〈 0.05）. And there were no differences of the incidence of DIC and the incidence of 28 - days mortality between the two groups（ P 0.05）. Conclusion Lowmolecular- weight heparin is of clinical value in improving the whole inflammatory reactivity and the high blood coaculation, but it needed further clinical study.

关 键 词：脓毒症 多器官功能衰竭 肝素 低分子量 

分 类 号：R365[医药卫生—病理学]