小剂量普通肝素治疗脓毒症的临床研究

摘要

Objective To explore the therapeutic effects of low-dose unfractionated heparin(UFH) therapy on sepsis. Methods Eighty-five sepsis patients were divided into two groups: heparin treatment group ( n = 45 )and routine treatment group (control group) (n =40). The patients of control group received a series of remedies,including broad-spectrum antibiotics in early stage, supplementing of circulation volume, protecting of mucosal membrane of stomach, correcting the water, electrolyte and acid-base disturbance, and nutrition and supportive therapy. The patients of UFH treatment group were treated with UFH 5 U/( kg · h) by continuous intravenous infusion for 7 days in addition to routine treatment. The difference of APACHE-Ⅱ score, CRP, coagulation markers and platelet count between two groups were analyzed before and after treatment. The hemorrhage complication and survival rate in 7 days and 28 days were compared between the two groups. Results The survival rate was 82.22％ and 62.50％ in UFH treatment group and control group respectively (P ＜ 0.05). There was no significant difference of coagulation markers and PLT count between the two groups before and after treatment (P ＞ 0. 05). The incidence of hemorrhage complication was not higher in UFH treatment group compared with that of control group (P ＞ 0.05 ).Conclusion UFH therapy can improve the survival rate of patients with sepsis.%目的 探讨小剂量普通肝素对脓毒症的治疗作用.方法 将2007年10月至2009年12月入住我院ICU的85例脓毒症患者分为普通肝素治疗组45例和对照组40例.对照组给予早期应用广谱抗生素和容量复苏、控制血糖、抑酸保护胃黏膜、纠正水、电解质和酸碱平衡紊乱、脏器支持、基础病因治疗、营养支持及对症治疗.普通肝素治疗组在进行上述治疗的同时加用普通肝素5 U/(kg·h),24 h持续静脉泵入,疗程为1周(或用至患者出现低凝状态或出血倾向,或用至患者出院或死亡).比较2组患者治疗前后APACHEⅡ评分、CRP、凝血指标及血小板计数的变化;比较2组7 d及28 d转归及2组出血并发症发生率.结果 普通肝素治疗组28 d生存率为82.22%(37/45),对照组为62.50%(25/40),2组间差异有统计学意义(P＜0.05).治疗后1周APACHEⅡ评分2组差异无统计学意义(P＞0.05),但可以看出普通肝素治疗组的评分较对照组改善更大;普通肝素治疗组治疗前后比较,差异具有统计学意义(P＜0.05);治疗后1周2组CRP差异无统计学意义(P＞0.05),但2组治疗前后组内比较差异均有统计学意义(P＜0.01或P＜0.05).2组治疗前后凝血功能的指标及血小板计数均差异无统计学意义(P＞0.05);与对照组相比普通肝素治疗组未增加出血并发症的发生率.结论 小剂量普通肝素治疗能显著改善脓毒症患者的生存率,且无严重并发症,临床应用安全.