持续小剂量肝素治疗严重脓毒症的疗效分析

摘要

目的 探讨持续小剂量肝素对严重脓毒症患者的临床疗效.方法 选择本院综合ICU病房67例严重脓毒性休克患者,分为常规组和肝素组,前者36例,采用常规治疗;后者3l例.在常规治疗基础上,于确诊严重脓毒症当日开始持续应用小剂量肝素,疗程5～7d.监测患者治疗前、后血小板、APTT、PT、FIB、AT-Ⅲ的变化及出血倾向,观察两组患者机械通气时间、急性呼吸窘迫综合征(ARDS)、弥散性血管内凝血(DIC)、急性肾衰竭(ARF)及多器官功能不全综合征(MODS)的发生率,统计患者7 d及28 d病死率.结果 肝素组患者的ARDS(38.71%vs 58.33%)、DIC(16.13%vs 27.78%)、MODS(32.26%VS 52.78%)发生率低于常规组.差异有显著性(P＜0.05),肝素组患者28 d病死率(29.03%)也较常规治疗gi(44.44%)降低(P＜0.05).两组患者在血小板计数、APTT、PT、FIB、AT-Ⅲ、机械通气时间、机械通气率、ARF发生率及7d病死率方面差异无显著性(P＞0.05).结论 持续小剂量肝素治疗严重脓毒症具有较高的安全性,可改善病情、降低病死率.%Objective To investigate the therapeutic effects of continuous low-dose heparin on severe sepsis.Mehoda 67 severe septic patients were randomly divided into tow groups:routine treat-ment group(n=36)and heparin treatment group(n=31).The levels of platelet(PET)count,APTr,PT,FIB and AT-Ⅲ were determined before and after treatment in two groups.The days of mechanical ventilation and the incidence nltes of disseminated intravascular coagulopathy(DIC),acute renal failure(ARF),acute respiratory distress syndrome(ARDS),multiple organ dysfunction syndrome(MODS),The 7-day and 28-dav mortalitv were observed.Results There are significant differences for the incidence rate of ARDS,DIC.MODS and 28-day mortality between routine treatment group and heparin treatment group(P＜0.05).And there are no siguificant differences for the levels of PLT count,APTT,PT,FIB,AT-Ⅲ,the days of mechanical ventilation,the incidence rate of ARF,7-day mortality between routine treatment group and heparin treatment group (P>0.05).Conclusion Continuous low-dose heparin on severe sepsis was sale relatively,and it could improve the prognosis and decrease the mortality rate of severe septic patients.