小剂量肝素和低分子肝素治疗创伤性弥漫性血管内凝血的临床研究  

Clinical study of low dose heparins and low molecular weight heparins for treatment of traumatic disseminated intravascular coagulation

作　　者：温隽珉[1] 陈怀生[1] 孙育欣 潘晓华[1] 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院重症医学科,广州518020 [2]暨南大学第二临床医学院深圳市人民医院骨科,广州518020

出　　处：《中华创伤杂志》2012年第8期736-740,共5页Chinese Journal of Trauma

基　　金：深圳市科技计划资助项目（200703130）

摘　　要：目的探讨对严重创伤性弥漫性血管内凝血（DIC）使用小剂量普通肝素或低分子肝素（LMWHs）的临床疗效。方法选择77例我院ICU收治、APACHEII评分5～10分且并发DIC的患者，按随机数字表法分为三组：A组（26例）为LMWHs组（75-150U·kg^-1·d^-1，初始平均剂量4000U／d）；B组（25例）为普通肝素组（100-250U·kg^-1·d^-1，初始平均剂量5000U／d），皮下注射根据抗凝血酶Ⅲ（ATⅢ）水平调整用量；对照组（26例）为单纯凝血因子补充组。比较各组在ICU28d内的病死率、住院天数、出血事件发生率和凝血酶时间（TT）、凝血酶原时间（frr）、活化部分凝血酶时间（AFIT）、纤维蛋白原（Fg）、ATⅢ及D-二聚体。结果三组28d病死率比较：A组与对照组比较，B组与对照组比较，差异均有统计学意义（P〈0．05）；（2）ICU住院天数：三组比较差异有统计学意义（P〈0．01），A、B组长于对照组（P〈0．01），A组长于B组（P〈0．05）；（3）凝血指标：除ATIU（P〈0．01）外，其他指标间比较，差异无统计学意义意义；（4）出血率：A组与对照组比较，差异无统计学意义（P〉0．05）；B组与对照组比较，差异有统计学意义（P〈0．05），A组与B组比较差异统计学意义（P〈0．05）；（5）相关因素分析显示血浆ATⅢ与出血率相关明显（P〈0．01）。结论使用肝素或LMWHs有助控制外伤性DIC，采用与出血率具有明显相关性的ATⅢ来调整肝素的用法比LMWHs具有更低的出血率。Objective To discuss the clinical efficacy of low dose heparins and low molecular weight heparins （LMWHs） in the treatment of severe traumatic disseminated intravascular coagulation （DIC）. Methods A total of 77 trauma patients （APACHE Ⅱ score for 5-10） with secondary DIC in ICU were included and randomly assigned to three groups, ie, Group A （26 patients, subcutaneously in- jected with LMWHs at doses of 75-150 U . kg^-1. d^-1, with the average incipient dose of 4 000 U/d）, Group B （25 patients, subcutaneously injected with heparins at doses of 100-250 U . kg^-1 . d^-1, with the average incipient dose of 5000 U/d and control group （26 patients, supplemented with simple blood coagulation factor）. The injection volume was adjusted according to the level of antithrombin Ⅲ （ATⅢ） in each group. Within 28 days in ICU, the three groups were compared in aspects of deaths, hospital day, bleeding rate, thrombin time （TT）, prothrombin time （PT）, activation part thrombin time （APTT）, fibrinogen （Fg）, antithrombin Ⅲ （AT Ⅲ） and D-dimer. Results （1） The differences of mortality were both insignificant in the control group compared with Group A and Group B respectively at day 28 （P 〈 0. 05 ）. （2） The ICU stay of three groups showed significant differences （P 〈 0.01 ）, with longer stay of Groups A and B than control group （ P 〈 0.01 ） and longer stay of Group A than Group B （ P 〈 0.05 ）. （3） Except for AT Ⅲ （ P 〈 0.01 ） , other blood coagulation indices showed no significantdifference among three groups. （4） The differences of bleeding rate were not significant between Group A and control group （ P 〉 0. 05 ）, but significant between Group B and control group （ P 〈 0.05 ）. （ 5 ） Re- lated factor analysis indicated significant relationship between ATⅢ level and bleeding rate （P 〈0.01 ）. Conehmions Low dose heparins and LMWHs are beneficial to controlling traumatic DIC, but the hepa- rin therapy adjusted by

关 键 词：弥漫性血管内凝血 肝素 低分子量 病死率 

分 类 号：R641[医药卫生—外科学] R554.8[医药卫生—临床医学]