低分子肝素钙联合血液净化治疗重症脓毒血症的临床研究

目的探讨低分子肝素钙联合血液净化治疗重症脓毒血症的临床效果。方法用随机数字分表法将该院收治的80例重症脓毒血症患者分为对照组与观察组各40例,其中对照组采用普通肝素(HP)联合血液净化治疗,观察组采用低分子肝素钙(LMWHC)联合血液净化治疗。比较治疗前后两组患者凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、血小板含量(PLT)]、血清炎症因子指标[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、血浆降钙素原(PCT)、血栓前体蛋白(TpP)]、肾功能指标[血肌酐(SCr)、血尿素氮(BUN)]及不良反应发生率(滤器凝血、管路凝血)的结果变化。结果治疗1周后,两组患者PT、TT、APTT水平均高于治疗前(P<0.05),且观察组均高于对照组(P<0.05);Fbg、PLT、IL-6、TNF-α、CRP、PCT、TpP、SCr、BUN水平均低于治疗前(P<0.05),且观察组均低于对照组(P<0.05);观察组不良反应发生率低于对照组(P<0.05)。结论LMWHC联合血液净化治疗重症脓毒血症可有效改善患者凝血功能与炎症反应,促进器官功能恢复。

Clinical study of low molecular weight heparin calcium combined with blood purification in treatment of severe sepsis

【Objective】To investigate the clinical effect of low molecular weight heparin calcium combined with blood purification in the treatment of severe sepsis.【Methods】Eighty patients with severe sepsis in our hospital were divided into control group and observation group by random number table method.The control group was treated with common heparin(HP)combined with blood purification,while the observation group was treated with low molecular weight heparin calcium(LMWHC)combined with blood purification.The indexes of coagulation function[prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(Fbg),platelet content(PLT)],serum inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP),plasma calcitonin(PCT),thrombus precursor protein(TpP)],renal function index[serum creatinine(SCr),blood urea nitrogen(BUN)]and incidence of adverse reactions(filter coagulation,pipeline coagulation)were compared before and after treatment.【Results】After one week of treatment,the levels of PT,TT,APTT in the two groups were significantly higher than those before treatment(P<0.05),which in the observation group were higher than those in the control group(P<0.05);Fbg,PLT,IL-6,TNF-α,CRP,PCT,SCr,BUN and TpP in the two groups were significantly lower than those before treatment(P<0.05),and the above indexes in the observation group were significantly lower than those in the control group(P<0.05);the total incidence of adverse reactions in the observation group was also significantly lower than that in the control group(P<0.05).【Conclusion】LMWHC combined with blood purification in the treatment of severe sepsis can effectively improve the coagulation function and inflammatory reaction,alleviate the condition and promote the recovery of organ function.