磺达肝癸钠和低分子肝素治疗创伤感染患者高凝状态的比较研究

摘要

目的：比较磺达肝癸钠与低分子肝素对于创伤感染患者高凝状态的治疗作用和不良反应。方法2012年2月～2013年2月我院重症监护治疗中心收治创伤感染合并高凝状态者36例，随机分成2组，一组患者采用磺达肝癸钠进行抗凝治疗（F组，18例），剂量为2.5mg，1次/d；另一组采用低分子肝素进行抗凝治疗（L组，18例），剂量为4100U/次，1次/12h，两组疗程均为11d。采用血凝分析仪测定纤维蛋白原、D-二聚体含量以及抗凝血酶III（ AT-Ⅲ）活性；比较两组患者用药后深静脉血栓发生率、出血事件发生率、多器官功能障碍综合征（ MODS）发生率以及死亡率。结果抗凝治疗后两组患者AT-Ⅲ总体呈现上升趋势，第5d和11d F组数值较L组高，有统计学差异（P＜0.05）。纤维蛋白原含量逐步上升，两组间无统计学差异（P＞0.05）。两组患者D-二聚体自抗凝治疗后第5d出现明显下降（P＜0.01），且第5d和第7d两组间比较有统计学差异（P＜0.05），第11d数值比较无统计学差异（P＞0.05）；两组患者深静脉血栓发生率、MODS发生率以及死亡率无统计学差异，F组出血事件发生率低于L组（P＜0.05）。结论低分子量肝素和磺达肝癸钠均可有效改善创伤感染患者合并的高凝状态。与低分子量肝素相比，磺达肝癸钠可降低创伤感染合并高凝状态患者出血风险。%Objective To compare the effects and side -effects of fondaparinux sodium and low molecular weight heparin for patients with hypercoagulability accompanied with traumatic infection .Methods Totally 36 pa-tients with post-traumatic infections in our intensive care center were diagnosed as coagulation dysfunction from Feb . 2012 to Feb.2013.These patients were randomly divided into 2 groups:one group was treated with fondaparinux so-dium (F group,18 cases),2.5mg,1/d;the other group was treated with low molecular weight heparin (L group,18 cases),4 100U,1/12h.The anticoagulant therapy lasted for 11 days.Fibrinogen,D-dimer level and activity of an-tithrombin Ⅲwere measured by coagulation analyzer .The incidence and mortality of deep vein thrombosis ,bleeding events and MODS of two groups after the anticoagulant therapy were analyzed .Results AT-Ⅲgot an upward trend after anticoagulant therapy,which was higher in F group than in L group at 5 days and 11 days(P<0.05).Fibrino-gen levels were gradually increased ,indicating no significant difference between the two groups (P>0.05).D-di-mer was significantly decreased at 5 days after anticoagulant therapy (P<0.01),and there were significant differ-ences at 5 days and 7 days between the two groups(P<0.05).There was no significant difference at 11 days after anticoagulant therapy ( P>0.05) .The incidences of deep vein thrombosis ,MODS incidence and mortality were not significantly differentiated between the two groups .The occurrence rate of bleeding in F group was lower than that in L group(P<0.05).Conclusion Fondaparinux sodium and low molecular weight heparin can effectively improve coagulopathy in patients with traumatic infection .Compared with the low molecular weight heparin ,fondaparinux so-dium may reduce the risk of bleeding in patients with hypercoagulability accompanied with traumatic infection .