小剂量低分子肝素在SAP中的治疗作用

目的讨小剂量低分子肝素对SAP的治疗作用。方法回顾性分析102例SAP病例资料,其中普通治疗组（G组）62例,小剂量低分子肝素（LMWH）治疗组（H组）40例。G组采用常规治疗;H组在G组上加用小剂量LMWH。比较治疗前后急性生理学与APACHEⅡ评分、血常规、血清尿淀粉酶、凝血指标、肝功能和肾功能、平均住院日、并发症率、死亡率、治愈率,部分病例（G组17例,H组11例）检测血清IL-6。结果（1）APACHEⅡ评分和IL-6水平：H组随治疗时间的延长,APACHEⅡ评分和IL-6水平均下降,治疗后1w与治疗前比较差异均有显著性（p〈0.05）;而G组呈现先降后升的趋势;治疗1w和2w后H组APACHEⅡ评分和IL-6水平均明显低于G组。（2）血常规明显异常者、血尿淀粉酶升高者、肝功能不全者及肾功能不全者所占比例：治疗前无明显差别（p〉0.05）,治疗1w和2w后H组亦明显低于G组（p〈0.05）。（3）凝血指标：H组在LMWH治疗前后比较凝血指标,凝血时间、凝血酶原时间和纤维蛋白原在入院时与治疗2w后均无明显差别（p〉0.05）。（4）H组平均住院日、并发症率、死亡率分别为（31＋9d）、32.7%、11.5%,明显短于G组的（43＋8d）、59.8%、27.6%（p〈0.05）。治愈率：H组（82.1%）明显高于G组（68.2%）（p〈0.05）。结论（1）小剂量LMWH能够通过减少炎症介质的释放而有效治疗SAP。（2）小剂量LMWH治疗能改善胰腺的微循环,提高SAP的疗效。（3）小剂量LMWH治疗SAP疗效确切,更具有安全性,不会引起严重出血并发症。

Therapeutic effect of small dosage of low molecular weight heparin on severe acute pancreatitis

Objective To investigate the therapeutic effect of small dosage of low molecular weight heparin （LMWH） therapy on severe acute pancreatitis（SAP）. Methods The clinical data of 102 cases of SAP were analysed retrospectively. Of them ,62 cases were treated by traditional methods of SAP （ G group ） , and 40 cases treated by traditional methods plus small dosage of LMWH treatment （ H group）. The score of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） ,complications, mean hospital stay time, motality and curative rate were observed ; and the amylase of serum and urine, blood routine, the parameters of coagulation, liver function and renal function were detected. In 28 cases ,including 17cases in G group and 11 cases in H group,serum IL -6 level were tested. Results （ 1 ） Both APACHE Ⅱ and IL - 6 levels in LMWH group were decreased with passage of time, the differences were significant between the results after one week and that of pretreatment （p 〈0.05）. In the routine treatment group, APACHE II and IL -6 levels were decreased first and then increased ,and they were higher than those in LMWH group one week and two weeks after treatment （p 〈 0. 05 ）. （2） Rate of abnormal of blood routine, amylase of serum and urine, liver function and renal function ： The rate in LMWH group was significantly lower than that in routine treatment group at 1 and 2 weeks after LMWH therapy （p 〈 0. 05 ） ; while there were no significant difference between LMWH group and routine treatment group before therapy （p 〉 0. 05 ） . （3）The parameters of coagulation： The values of CT , PT and FIB showed no significant difference before and after LMWH therapy （p 〉 0. 05 ） . （4） In LMWH group, the average hospital stay＇time was（31 ± 9）days,the complication rate was 32.7% ,the mortality rate wasl 1.5% , and they all were lower than those in routine treatment group（ （43 ± 8 ） days ,59.8% and 27.6% ] （p 〈 0. 05 ）. The curative rate was 82.1% in LMWH