肝素早期干预防治急性呼吸窘迫综合征患者凝血功能异常的临床研究  

The research of heparin in the early intervention to prevent Coagulant function abnormality in patients with ARDS

作　　者：唐召力[1] 唐夏楠 周涛[1] 覃壁云 曾广志[1] 唐海莲[1] 

机构地区：[1]南方医科大学附属柳州医院重症医学科,广西柳州545007

出　　处：《临床急诊杂志》2015年第12期926-928,共3页Journal of Clinical Emergency

摘　　要：目的：探讨肝素早期干预防治急性呼吸窘迫综合征（ARDS）患者凝血功能异常的临床效果。方法：将162例ARDS患者随机分为2组,其中对照组73例,肝素组89例。对照组给予常规治疗（包括维护脏器功能、手术干预、机械通气、抗感染、营养支持等）。肝素组给予常规治疗＋肝素,肝素每天剂量为6 250-18 750U,将凝血酶原时间（PT）和活化部分凝血酶时间（APTT）控制在正常值的2-3倍,并根据PT和APTT复查的结果调整肝素的用量,连续7-14d。所在转入ICU后第1天、第3天、第7天、第14天查PLT、D-二聚体;统计2组第14天病死率。结果：2组的D-二聚体水平在确诊ARDS后第1天即明显升高,但肝素组第3天、第7天、第14天D-二聚体水平明显低于对照组。2组的PLT水平在确诊ARDS后第1天即开始降低,第3-7天跌至低谷,但肝素组第3天、第7天、第14天PLT水平明显高于对照组。肝素组病死率为25.8%,明显低于对照组的46.5%。结论：ARDS患者多存在高凝状态和凝血功能异常,PLT降低主要是由于微小血栓形成消耗大量PLT所致。早期使用肝素能够抑制血栓形成,阻断血小板（PLT）消耗,对防治凝血功能异常具有良好效果。Objective：To explore clinical effect of heparin in the early intervention to prevent coagulant function abnormality in patients with ARDS.Method：162ARDS patients were randomly divided into 2groups,including the control group（73cases）and the heparin group（89cases）.Routine treatment was given to the control group（including maintenance of organ function,surgical intervention,mechanical ventilation,anti-infection and nutrition support,etc.）.Routine treatment plus heparin were given to the heparin group（heparin 6 250-18 750Udaily）for7to 14 days.PT and APTT was controlled in 2-3times of the normal value.The dosage of heparin was adjusted according to the result of PT and APTT.PLT and D-dimer were examined at the first,3th,7th,14 th day for all cases after transferred to the ICU.The mortality statistics of two groups were made at 14 th day.Result：D-dimer level was obviously increased in both groups at the first day,but the d-dimer level of the heparin group was significantly lower than that of the control at 3th,7th,14 th day.PLT level was decreased in both groups at the first day.But PLT level of the heparin group was significantly higher than that of the control at 3th,7th,14 th day.The mortality of the heparin group was 25.8% and was significantly lower than that of the control（46.5%）.Conclusion：High coagulability and coagulant function abnormality were found in most patients with ARDS.The most common cause of PLT decreasing is thrombosis.Early intervention with heparin can inhibit thrombosis and block the exhaust of PLT,and is effective to prevent coagulant function abnormality for ARDS patients.

关 键 词：肝素 早期干预 急性呼吸窘迫综合征 凝血功能异常 

分 类 号：R56[医药卫生—呼吸系统]