即时凝血功能监测在弥散性血管内凝血患者治疗中的应用  

The significance of immediate coagulation monitoring during the treatment for DIC

作　　者：万鹏[1,2] 余旻[1,2] 童华生[3] 苏磊[3] 

机构地区：[1]三峡大学人民医院 [2]宜昌市第一人民医院重症医学科,湖北宜昌443002 [3]广州军区总医院重症医学科,全军热区创伤救治与组织修复重点实验室,广州510010

出　　处：《解放军医学杂志》2015年第8期632-637,共6页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金面上项目(81471839)~~

摘　　要：目的探讨即时凝血功能监测(Sonoclot分析仪)在弥散性血管内凝血(DIC)个体化治疗中的价值。方法将符合纳入标准的237例显性DIC患者随机分为对照组(n=121,采用传统凝血指标指导替代和抗凝治疗)和Sonoclot组(n=116,采用Sonoclot分析仪指导替代和抗凝治疗)。观察两组患者抗凝、替代治疗以及预后之间的差异。结果治疗前两组患者一般临床资料比较无明显差异(P>0.05)。与对照组相比,Sonoclot组中使用肝素比例增加,抗凝时间缩短,肝素用量减少,局部出血比例下降,血浆、血小板及冷沉淀用量减少(P<0.05),且ICU住院时间缩短,30d生存率显著改善(P<0.05)。结论即时凝血功能监测可对血液制品成分进行合理的选择和数量控制,同时还可有效指导抗凝治疗,降低抗凝治疗致的出血风险,降低DIC患者死亡率。Objective To explore the value of application of immediate coagulation monitor, with the use of Sonoclot analyzer in the treatment of disseminated intravascular coagulation （DIC）. Methods Two hundred and thirty-seven DIC patients were randomly divided into Sonoclot group （n=116, guided by Sonoclot analyzer） and control group （n=121, guided by traditional coagulation indexes） according to the principle of random number. The type, dose and duration of replacement treatment, and the outcomes such as complication rate, ICU stay and 30-day survival rate were recorded and compared. Results There were no difference in the demographic data between two groups （P〉0.05）. In Sonoclot group, the ratio of heparin used was much higher, though with shorter duration and lower dose than those in control group （P〈0.05）. The regional bleeding rate was significantly lower in Sonoclot group than that of control group （P〈0.05）. The replacement doses of the fresh frozen plasma, PLT, and cryoprecipitate were also much lower in the Sonoclot treatment group （P〈0.05）. A shorter ICU stay was found in the Sonoclot group （P〈0.05）. In sonoclot group the prognosis was significantly improved as shown by Kaplan-Meier analysis curve （P〈0.05）. Conclusions Sonoclot analysis is helpful in choosing rational blood products and necessary dosage. It is also useful for effectively guiding anticoagulant therapy in order to reduce the bleeding risk and mortality rate in DIC patients.

关 键 词：弥漫性血管内凝血 即时凝血功能监测 输血 

分 类 号：R554.8[医药卫生—血液循环系统疾病]