小剂量肝素在治疗脓毒症合并凝血功能障碍中的优势

目的 探讨小剂量肝素对脓毒症高凝状态的影响.方法 正常组30例,分别测其凝血酶原片段(F1+2),凝血酶抗凝血酶复合物(TAT)的血浆水平取正常参考值范围;脓毒症F1+2、TAT升高患者27例,随机分为肝素治疗组(实验组)和非肝素治疗组(对照组).27例患者均给予常规抗感染、早期目标下液体复苏等治疗,除此以外,实验组在早期给予小剂量肝素[70 U/(kg*24 h)]持续泵入.监测并记录两组治疗5 d前后F1+2、TAT水平,计算治疗前后的APACHE-Ⅱ评分、入住ICU及呼吸机使用时间和28 d病死率.结果 实验组的F1+2、TAT治疗后较治疗前明显降低,差异有显著性(P=0.000,0.042).对照组治疗前后F1+2、TAT无显著性差异(P=0.742,0.208).实验组呼吸机使用天数(9.25±6.02) d及ICU住院时间(10.33±5.50) d明显短于对照组[(17.20±9.48)d,(16.20±10.03)d;P=0.045,0.036].两组APACHE-Ⅱ评分在治疗前差异无显著性(P=0.708),治疗后两组评分均有所降低,但实验组差异显著(P=0.027).两组之间28 d生存率无显著性差异(P=0.643).结论 对于处于脓毒症高凝期的患者,早期给予小剂量肝素治疗可改善患者的高凝状态,缩短住院时间及呼吸机使用时间,但未能改善生存率.

Low-dose heparin for treatment of sepsis in the hypercoagulable period

Objective To investigate the low-dose heparin in patients with sepsis of hypercoagulability.Methods 30 adults be measured the prothrombin fragment(F1+2) and thrombin-antithrombin complex(TAT) level of blood plasma to estimate the reference value.27 cases of adult patients in sepsis hypercoagulable period were randomly divided into heparin-treatment group(the experiment) and non-heparin treatment group(the control).27 patients were given routine anti-infective,early-goal fluid resuscitation treatment,while t...