不同监测方法指导下的脓毒症凝血功能障碍患者的肝素抗凝治疗研究  

Study on heparin anticoagulation therapy for sepsis patients with coagulation dysfunction under different monitoring methods

作　　者：王曼 谭奕东[1] 温福铭[1] 李乐[1] WANG Man;TAN Yidong;WEN Fuming;LI Le(Department of EICU,the People’s Hospital of Guigang,Guigang,G uangxi,537100,China)

机构地区：[1]广西贵港市人民医院急救中心EICU,广西贵港537100

出　　处：《临床急诊杂志》2021年第2期87-91,共5页Journal of Clinical Emergency

基　　金：贵港市科学研究与技术开发计划项目(No:贵科转1803009)。

摘　　要：目的:观察血栓弹力图与传统凝血指标监测指导下的脓毒症凝血功能障碍患者的肝素抗凝效果。方法:将105例DIC评分≥3分的脓毒症患者随机分为血栓弹力图(TEG)组、活化部分凝血活酶时间(APTT)组和安慰剂组。TEG组与APTT组于入院当天给予肝素连续输注,TEG组根据R值调整肝素输注剂量,APTT组根据活化部分凝血活酶时间调整肝素输注剂量,安慰剂组给予等量盐水输注。对比组间肝素使用情况及临床评价指标。结果:与安慰剂组相比,TEG组与APTT组患者进展为显性DIC发生率与深静脉血栓发生率较低,呼吸机使用时间与ICU住院时间较短,出血发生率及MODS发生率无明显升高,28 d病死率差异无统计学意义。TEG组的肝素使用时间较APTT组短,且肝素使用剂量较小,两组在出血发生率上的差异无统计学意义。结论:脓毒症相关凝血功能障碍患者的早期抗凝治疗可能是有效且相对安全的,TEG监测脓毒症患者抗凝治疗可能是更优选择。Objective: To observe the therapeutic effect of heparin anticoagulation therapy in patients with sepsis related clotting dysfunction under the guidance of thrombelastogram and traditional coagulation indexes monitoring. Methods: A total of 105 sepsis patients with DIC score ≥3 were randomly divided into TEG group, APTT group and placebo group. TEG group and APTT group were given heparin continuous infusion on the day of admission. Heparin infusion dose was adjusted according to R value in TEG group, and according to APTT ratio in APTT group. The heparin dose and clinical evaluation index were compared between different groups. Results: Compared with the placebo group, patients in the TEG group and the APTT group had a lower incidence of progressive dominant DIC and deep venous thrombosis, shorter duration of ventilator use and ICU stay, no significant increase in the incidence of bleeding and MODS, and no statistically significant difference in the 28-day mortality. The heparin use time of TEG group was shorter than that of APTT group, and the heparin use dose was smaller. There was no statistically significant difference in the incidence of bleeding between the two groups. Conclusion: Early anticoagulation therapy in patients with sepsis associated coagulation dysfunction may be effective and relatively safe, and TEG monitoring of anticoagulation therapy in patients with sepsis may be a better choice.

关 键 词：脓毒症 弥散性血管内凝血 血栓弹力图 肝素 抗凝监测 

分 类 号：R631.2[医药卫生—外科学]