严重脓毒症早期应用小剂量肝素治疗的临床意义

摘要

目的 探讨小剂量肝素在严重脓毒症早期患者中应用的临床价值.方法 选择严重脓毒症患者40例,随机分为两组:对照组和试验组.对照组行常规脓毒症治疗,试验组除常规治疗外,早期应用小剂量肝素.在入住ICU后每日行APACHE Ⅱ评分、SIRS评分;并记录患者氧合指数、肌酐以及凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数等,以及患者住ICU的时间、28 d病死率.结果 治疗后,试验组APACHEII评分、SIRS评分较治疗前明显减低(P＜0.05);氧合指数升高且血清肌酐下降(P＜0.05);PT和APTT缩短、血小板计数升高(P＜0.05).对照组APACHE II评分、SIRS评分等观察指标较治疗前无明显变化.住ICU的时间试验组明显短于对照组(P＜0.05);28 d病死率两组之间无显著差异.结论 早期小剂量肝素治疗可明显减轻严重脓毒症患者的病情及全身炎症反应,改善肺部氧合、肾功能及凝血功能,缩短患者在ICU的住院时间,对生存率影响不大.%Objective To study the therapeutic effects of low - dose heparin on early administration of patients with severe sepsis.Methods Forty patients with severe sepsis were divided into two groups: control and trial group. The routine treatments were given to patients in control group, while low - dose heparin was given additionally in trial group. APACHE Ⅱ and SIRS score, oxygenation index, serum creatinine, prothrombin time (PT), activated partial thromboplastin time (APTT), blood platelet count, days staying in ICU and 28 -day fatality were investigated in the two groups. Results After the treatment of heparin, APACHE Ⅱ score, SIRS score, serum creatinine, PT and APTT were decreased, while oxygenation index increased in trial group ( P ＜ 0.05 ). Moreover, days staying in ICU was shorter in trial group than that in control group (P ＜0.05 ). There was no significant difference in 28 -day fatality between the two groups. Conclusion The early therapy of low - dose heparin could improve oxygenation index, renal function and coagulative function in patients with severe sepsis. However, 28 -day fatality was not improved.