低分子肝素抗凝治疗急性胰腺炎

目的 了解低分子肝素抗凝治疗急性胰腺炎对预后的影响.方法 确诊急性胰腺炎并符合本研究标准的73例患者分为抗凝组(38例)及对照组(35例),观察其血清学检测指标和预后.结果 低分子肝素抗凝治疗能明显改善急性胰腺炎患者的血细胞及动脉血气指标,缩短住院时间,并能在一定程度上降低急性水肿型胰腺炎的重症化率、再手术率和病死率.不会加重重症急性胰腺炎的出血倾向.结论 低分子肝素抗凝治疗急性胰腺炎足安全、有效的,初步观察能明显改善患者的预后.     

乌司他丁联合低分子肝素治疗急性胰腺炎临床效果分析

目的 探讨乌司他丁联合低分子肝素用于急性胰腺炎治疗的临床效果.方法 选取2015年2月至2021年3月北京中西医结合医院就诊的急性胰腺炎患者160例,按照随机数字表法分两组,每组各80例,两组均常规给予胃肠减压、抑制胃酸及胰液分泌、抗炎、补液等治疗,对照组另加用低分子肝素钙,观察组另加用乌司他丁+低分子肝素钙.观察比较...     

低分子肝素与常规西药治疗先兆流产有效性和安全性的Meta分析

目的 系统评价低分子肝素治疗先兆流产的有效性和安全性,为临床提供循证参考.方法 检索Pubmed、中国知网、万方数据库、维普数据库,检索时间为建库时间至2020年3月,收集有关低分子肝素治疗先兆流产的随机临床试验(RCT).由2位研究员按纳入和排除标准独立进行文献筛选、资料提取和偏倚风险评价,用ReV Man5.3软件...     

低分子右旋糖酐治疗急性胰腺炎的临床观察

急性胰腺炎(acute pancreatitis,AP)是临床上常见的急腹症之一,部分病人可能恶化并出现器官功能衰竭或局部并发症（包括坏死、假性囊肿和脓肿）成为重症AP。重病AP临床表现凶险,病死率高,治疗尚缺乏有效的措施。我们对32例AP,除采用常规治疗以外,加用低分子右旋糖酐,取得了较好的治疗效果,现报道如下。     

低分子肝素治疗糖尿病肾病的临床分析

糖尿病肾病是糖尿病的严重微血管病变,是导致终末期肾功能衰竭的主要原因之一。糖尿病肾病患者血液多呈高凝状态,肾小球内凝血、血栓形成,导致肾功能衰竭进展加剧。我院应用低分子肝素治疗糖尿病肾病,改善肾小球内高凝状态,修复肾小球基底膜电荷屏障,明显延缓糖尿病肾病的病程进展。     

低分子量肝素治疗重症急性胰腺炎

目的探讨低分子量肝素(LMWH)治疗重症急性胰腺炎(SAP)的疗效.方法回顾性分析对比LMWH治疗组(LT组)31例和常规治疗组(RT组)48例的疗效.结果LT组31例中治愈28例(90.3%),死亡3例(9.7%).RT组48例中治愈35例(72.9%),死亡13例(27.1%).LT组的并发症发生率32.3%(10例,18例次)明显低于RT组并发症的发生率62.5%(30例,59例次)(P<0.01);LT组胰腺坏死清除加腹腔持续灌洗引流术的手术率(3.1%)较RT组胰腺坏死清除加腹腔持续灌洗引流术的手术率(25%)明显降低(P<0.01);LT组平均住院日(29±7)d较RT组平均住院日(41±9)d明显减少(P<0.01).结论LMWH能改善胰腺微循环、减轻缺血-再灌注损伤、对SAP有重要的辅助治疗作用.     

桃红四物汤联合低分子肝素预防骨科术后深静脉血栓 Meta分析

目的:系统评价桃红四物汤联合低分子肝素预防骨科术后深静脉血栓形成(DVT)的疗效及安全性。方法:全面检索 Cochrane Library、EMbase、PubMed、JAMA、CNKI、维普和万方数据库中收录的桃红四物汤联合低分子肝素预防骨科术后 DVT的随机对照研究(RCT),检索时限从建库— 2020年 6月。有两位研究者独立筛选文献、资料提取和质量评价后,采用 RevMan5.4软件进行 Meta分析。结果:共纳入 14项 RCTs,入选 1150例患者。 Meta分析结果显示,与低分子肝素组相比,联合组显著降低了 DVT发生率 [RR=0.32,95% CI(0.20,0.51),P<0.00001];联合组的视觉模拟评分法(VAS)疼痛评分 [MD=-1.20,95%CI(-1.39,-1.02),P<0.00001]、术后伤口引流量 [MD=-35.86,95%CI(-41.81, -29.90),P<0.00001]、血小板计数(PLT)[MD=-9.49,95%CI(-13.33,-5.66),P<0.00001]、红细胞计数(RBC)[MD=0.29, 95%CI(0.23,0.36),P<0.00001]、活化部分凝血活酶时间(APTT)[MD=1.94,95%CI(1.33,2.55),P<0.00001]、血红蛋白(HGB)[MD=4.70,95%CI(3.25,6.15),P<0.00001]、D-二聚体 [MD=-0.06,95%CI(-0.07,-0.06), P<0.00001]以及 C反应蛋白(CRP)[MD=-1.63,95%CI(-1.94,-1.32),P<0.00001]显著优于对照组;凝血酶原时间(PT)在两组比较中无统计学意义(P>0.05)。结论:桃红四物汤联合低分子肝素预防骨科术后 DVT疗效优于单用低分子肝素,且减少术后下肢深静脉血栓的形成。     

低分子量肝素对重症急性胰腺炎并发症的治疗作用

目的 :探讨低分子量肝素 (LMWH)对重症胰腺炎 (SAP)患者的疗效。方法 :回顾对比分析LMWH治疗组 31例和对照组 4 8例的疗效情况。结果 :治疗组 31例中治愈 2 8例 (占 90 .3% ) ,死亡 3例 (占 9.7% )。对照组 4 8例中治愈 35例 (占 72 .9% ) ,死亡 13例 (占 2 7.1% )。治疗组平均住院时间 (2 9± 7)d ,较对照组平均住院时间 (41± 9)d明显减少 (P <0 .0 1)。治疗组的并发症发生率 (32 .3% ,10例 18例次 )明显偏低于对照组 (6 2 .5 % ,30例 5 9例次 ) (P <0 .0 1)。结论 :LMWH能改善胰腺微循环、减轻缺血 再灌注损伤 ,对SAP有较好的辅助治疗作用     

低分子肝素治疗肾病综合征临床观察

为了观察低分子肝素对原发性肾病综合征的疗效 ,我们对完全符合肾病综合征诊断标准的患者 110例作了临床观察。资料与方法1　临床资料　该 110例患者均为我院住院或门诊病人。随机分为两组 ,治疗组 60例 ,对照组 5 0例。两组在性别、年龄及尿蛋白定量方面无明显统计学意义。对照组给予标准激素疗法及对症处理 ,观察组在上述药物治疗的基础上加用低分子肝素 (广东天普生物化学制药有限公司研究所生产 ) 5 0 0 0μ皮下注射 ,每日 2次。2　观察指标　所有病例均为每周测尿蛋白 ,测凝血酶原时间 (ＰＴ) ,部分凝血活酶时间 (ＫＰＴＴ ) ,纤维蛋白…     

低分子肝素联合激素、环磷酰胺治疗难治性肾病综合征的Meta分析

目的评价低分子肝素联合激素、环磷酰胺治疗难治性肾病综合征(refractory nephrotic syndrome,RNS)的疗效。方法电子检索知网、万方、维普、PubMed、EMbase和Cochrane Library数据库,检索时间均从建库至2018年3月,收集低分子肝素联合激素、环磷酰胺治疗RNS的临床随机对照试验(randomized controlled trials,RCT),根据纳入和排除标准筛选文献、质量评价及数据提取后,采用Revman5.3软件进行Meta分析。结果共纳入15篇中文RCT研究,1077例RNS患者,其中试验组542例,对照组535例。Meta分析结果显示,试验组完全缓解率[OR=2.28,95%CI(1.76,2.95),P<0.00001]明显高于对照组,同时实验组24 h尿蛋白定量[MD=-1.14,95%CI(-1.57,-0.72),P<0.00001]、血肌酐[MD=-7.81,95%CI(-8.87,-6.75),P<0.00001]、尿素氮[MD=-1.81,95%CI(-1.88,-1.74),P<0.00001]均明显优于对照组。结论对于我国RNS患者,低分子肝素联合激素、环磷酰胺治疗疗效显著,但仍需要更多高质量的RCT进一步证实。     

低分子肝素和乌司他丁联合治疗对急性胰腺炎患者血清C反应蛋白的影响

目的：观察低分子肝素（LMWH）与马司他丁（UTI）联合治、厅对急性胰腺炎思者血滑C反应蚩臼（CRP）的影响及治疗效果。方法：2004年6月－2008年3月收治的100例急性胰腺炎患者随机分为4组：对照组（常规给予禁食水、胃肠减压、抑制胃酸和胰液分泌、补液、预防感染和镇痛解痉等治疗）、LMWH组（常规治疗＋LMWH5kU皮下注射,12h1次）、UTI组（常规治疗-UTI100kU静脉滴注,8h1次）、LMWH＋UTI组（常规治疗＋LMWH5kU皮下注射,12h1次＋UTI100kU静脉滴注,8h1次）。观察各组第1、3、7天时的血清CRP水平、平均治愈时间及转手术治疗、重症化和死亡例数。结果：治疗第1～7天LMWH及UTI组均可显著降低血清CRP水平,第3、7天时LMWH及UTI可协同降低CRP水平。LMWH和UTI均可缩短治愈时间,但二者之间无协同作用。结论：LMWH联合UTI治疗急性胰腺炎可降低CRP水平,缩短病程。     

低分子量肝素预防重症急性胰腺炎并发胰性脑病的前瞻性临床研究

目的探讨低分子量肝素(low molecular weight heparin,LMWH)预防重症急性胰腺炎(severe acute pancreatitis,SAP)并发胰性脑病的临床价值。方法将265例SAP病例随机分为两组:(1)常规治疗组(C组)130例,(2)LMWH治疗组(常规治疗加LMWH治疗,LT组)135例。分析对比两组APACHEⅡ评分、胰腺CT坏死程度、血淀粉酶、尿淀粉酶、胰性脑病的发生率、死亡率、治愈率、平均住院日。结果(1)治疗2周后LT组APACHEⅡ评分明显低于C组(P<0.05)。(2)治疗1、2周后,LT组胰腺CT坏死程度均较C组明显减轻。(3)治疗1、2周后,LT组血、尿淀粉酶均明显低于C组(分别P<0．05,P<0．05,P<0．001,P％0．001)。(4)LT组胰性脑病的发生率(2．2％)显著低于C组(10．0％),LT组死于胰性脑病者(0．7％)亦显著低于C组(4．6％),分别P％0．01, P<0．05。(5)LT组死亡率(10．0％)显著低于C组(30．6％);LT组治愈率(90．0％)显著高于C组(69．4％)(均P<0．001)。(6)LT组平均住院日(30±8)d明显低于C组(43±11)d,P<0．001。结论LMWH可抑制胰酶的释放,减少脑神经元细胞凋亡和减少炎症因子的产生,从而降低胰性脑病的发生率和死亡率。     

Antiproliferative effects of low molecular weight heparin

AIM: To investigate the effect of low molecular weight heparins (LMWH) on the inhibition of intimal hyperplasia (IH) developing in prosthetic vascular patch graft implanted into sheep carotid artery. METHODS: A gelatin sealed Dacron patch graft was implanted into the common carotid artery of sheep, which were then allocated to a control group (n = 10) or to one of four treatment groups (each group n = 10) receiving either a low dose (LD) or high dose (HD) of one of two LMWH (enoxaparin 1 or 2 mg/kg/day, dalteparin 100 or 200 units/kg/day) administered subcutaneously for 4 weeks. Anti-activated factor X and activated partial thromboplastin time were assayed from blood collected prior to and at 1 and 2 h after LMWH administration on days 3, 7, 14, 21 and 28. Animals were killed on day 28 after taking blood samples prior to, then at 0.5, 1, 2, 3, 4, 6, 8, 12 and 24 h following the last injection. Grafts were collected for analysis and measurements of intimal thickness obtained under light microscopy from eight transverse sections of each grafted artery aided by computer image analysis. An IH index was calculated by dividing the area of IH (mm2) by the width of the graft (mm). RESULTS: Intimal hyperplasia index measurements (mean +/- SD) were: controls 0.574 +/- 0.077, LD enoxaparin 0.471 +/- 0.056, LD dalteparin 0.404 +/- 0.025, HD enoxaparin 0.398 +/- 0.068, HD dalteparin 0.332 +/- 0.048. The reductions in IH index compared to controls were significant (P < 0.05) for both LD and HD dalteparin and for HD enoxaparin. CONCLUSION: Both LMWH dalteparin and enoxaparin reduced the amount of IH formation with dalteparin showing a greater effect in the present animal study. The possibility that different LMWH might exert differing antiproliferative effects requires further investigation.     

低分子肝素对血液透析患者脂质代谢影响的临床研究

目的 探讨长期应用低分子肝素抗凝对尿毒症血液透析患者脂质代谢的影响。方法 采用为期１年的长期开放、随机对照的方法,选择３５例无明显出血倾向尿毒症患者,随机分成普通肝素（ＵＦＨ）组（１３例）及低分子肝素（ＬＭＷＨ）组（２２）例,于透前分别按个体剂量给予普通肝素及低分子肝素钠动脉血路端注射,并在治疗前、治疗后６月及１２月检测血脂、脂蛋白、载脂蛋白水平及脂酶活性。结果 （１）两治疗组透析前血甘油三酯（Ｔ     

低分子量肝素在血液透析中的应用

为探讨低分子量肝素在血液透析中的抗凝作用，选择血液透析患者６０例、１５００例次，分成两组。一组透析中使用肝素抗凝，另一组使用低分子量肝素（ＣＸ）抗凝，分别测量凝血时间、凝血酶原时间、活化部分凝血活酶时间及血小板，进行对照研究。结果发现，ＣＸ比肝素能更有效地抗凝，又能减少出血倾向，透析器复用次数明显增加，活化部分凝血活酶时间降低（Ｐ＜０．０１）。表明低分子量肝素特别适用于有出血倾向者，可代替肝素在血液透析中应用。     

Lack of efficacy of low molecular weight heparin in a boy with congenital nephrotic syndrome

SUMMARY: The congenital nephrotic syndrome (CNS) is characterized by severe proteinuria, followed by hypoalbuminaemia and hypercoagulopathy. the boy was born in the 39th gestational week (1980 g bodyweight). In the first days of his life, he developed proteinuria and oedema, and on the 10th day, a thrombosis of the vena cava inferior was diagnosed. the boy was treated with unfractionated heparin, antithrombin concentrates and a low-dose of recombinant tissue plasminogen activator (rtPA). After 2 days, a complete resolution of the thrombus was observed. Treatment with unfractionated heparin and antithrombin III was continued. At the age of 3 months, low molecular weight heparin (LMWH) was started before the patient was discharged. Despite a high dose of LMWH, 250 IU/kg bodyweight, the anti-Xa-activity was always below 0.1 U/mL. Therefore, anticoagulation was achieved by the administration of vitamin K antagonist. Low molecular weight heparin is bound to albumin and antithrombin. Therefore, the renal loss of these proteins may result in low plasma levels of LMWH, and may not be effective in patients with CNS.     

Effect of low molecular weight heparin on fracture healing in a stabilized rat femur fracture model.

The purpose of this study was to evaluate the effect of low molecular weight heparin (LMWH) on fracture healing in a standard stabilized rat femur fracture model. A closed, mid-diaphyseal transverse fracture was created in the right femur of Long-Evans rats after insertion of a 0.8-mm K-wire into the medullary canal. Animals were randomized to receive either LMWH (70 units/kg dalteparin) or an injection of normal saline daily for 2 weeks. Animals were sacrificed at 2, 3, and 6 weeks. Fracture healing was assessed by radiographs, histology, and mechanical testing. There were no significant differences between the control and LMWH groups in the percentage of animals with radiographic bridging callus at each time point. Histologic appearance of fracture healing was similar between the control and LMWH groups. There were no significant differences in the normalized mechanical properties of the control and LMWH groups at 2 and 3 weeks. At 6 weeks, the percent torque of the LMWH group was significantly greater than the control group ( p = 0.0072), however, there was no significant difference in the stiffness and energy absorption. Dalteparin, at the dosage used in this study, did not impair fracture healing in this standard stabilized rat femur fracture model.