小剂量肝素对脓毒症患者脏器功能及预后的影响

摘要

Objective To observe the effects of low-dose heparin on organ function and prognosis in patients with sepsis. Methods In this retrospective study,54 patients who were clinically diagnosed with sepsis in the Department of Critical Care Medicine at the First Affiliated Hospital of Dalian Medical University were included from January 2010 to December 2011. The patients were divided into low-dose heparin group and control group.In addition to the routine treatment, the patients in low-dose heparin group were given low-dose heparin, while those in control group were not.The levels of APTT, PT, platelet ( PLT) count, hepatic function and renal function were analyzed before and after treatment in two groups, and hem-orrhagic events or other complications were recorded.The length of stay in ICU and Hospital, the days of mechanical venti-lation and the rates of acute respiratory distress syndrome ( ARDS ) , disseminated intravascular coagulation ( DIC ) and multiple organ dysfunction syndrome ( MODS) and 28 -day survival rate were recorded in the two groups.Results The rates of DIC and MODS in low-dose heparin group decreased significantly after therapy:rate of DIC, 10.6%vs.26.7%(P<0.05);rate of MODS, 19.3%vs.32.0%(P<0.05).Hepatic function and renal function in low-dose heparin group were significantly improved than that in control group (P<0.05);28-day survival rate in the low-dose heparin group was higher than that in control group (76.0%vs.61.5%, P<0.05).The differences between low-dose heparin group and control group were not statistically significant in the length of stay in ICU and Hospital, the days of mechanicalventilation and the rate of ARDS ( P>0.05) .The differences in APTT, PT and PLT were not significant before and after treatment and between the two groups (P>0.05).Conclusions Low-dose heparin decreases the rate of MODS and im-proves organ function and 28-day survival rate in patients with sepsis.It is a safe and promising therapy in sepsis patients without severe side effects.%目的：观察应用小剂量肝素对脓毒症患者脏器功能及预后的影响。方法回顾性分析2010年1月—2011年12月期间入住大连医科大学附属第一医院重症医学科的54例临床确诊为脓毒症患者的临床资料，依据入院后是否24 h内应用肝素分为肝素组27例与对照组27例。分析两组患者治疗前后APTT、PT、PLT、肝功能、肾功能的变化及出血倾向；比较两组患者住ICU时间，住ICU期间机械通气时间，住ICU期间ARDS、DIC、MODS发生率，住院时间，28 d生存率。结果肝素组DIC（10．6％）、MODS（19．3％）的发生率明显低于对照组（26．7％、32．0％；P＜0．05）。肝素组肝肾功能改善优于对照组。肝素组28 d生存率（76．0％）较常规对照组（61．5％）明显升高（P＜0．05）。两组在住ICU时间、住院时间、机械通气时间、ARDS发生率方面差异无显著性意义（P＞0．05）。两组患者出血情况，APTT、PT、PLT水平治疗前后组内及组间比较差异均无显著性意义（ P＞0．05）。结论脓毒症患者应用小剂量肝素治疗能改善肝肾等重要脏器功能，降低MODS的发生率及改善28 d生存率，临床应用相对较安全，无严重并发症发生。