不同剂量肝素治疗肿瘤患者术后合并DIC的疗效观察

目的 比较不同剂量肝素治疗实体肿瘤术后合并弥散性血管内凝血(DIC)的疗效和安全性。方法 58例实体肿瘤术后合并DIC患者随机分为两组:微剂量肝素组30例,中小剂量肝素组28例。微剂量肝素组每天微量泵持续泵入普通肝素量为10~25 mg;中小剂量肝素组每天微量泵持续泵入普通肝素量为50~100 mg;疗程3~5天,两组其他治疗原则相同,观察两组治疗前及治疗后的凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、血小板计数(PLT)、纤维蛋白原(Fbg)、D-二聚体(D-D);记录治愈率、出血情况、入住ICU时间、呼吸机使用天数及28天病死率。结果 治疗后两组的PT、APTT较治疗前,差异无统计学意义(P＞0.05),其他实验室指标与治疗前比较,差异有统计学意义(P＜0.05);微剂量肝素组和中小剂量肝素组治愈率分别是46.7%和21.4%,两组比较差异有统计学意义(P＜0.05);微剂量肝素组的1例患者用肝素后出血情况加重;中小剂量肝素组7例患者用肝素后出血情况加重,两组比较差异有统计学意义(P＜0.05);入住ICU时间及呼吸机使用天数,微剂量肝素组明显低于中小剂量肝素组(P＜0.01);两组比较28天病死率差异无统计学意义(P＞0.05)。结论 微剂量肝素治疗实体肿瘤术后合并DIC较中小剂量肝素疗效好,降低出血风险,提高治愈率,尤其适用于老年人和内出血患者。

Effect of different dose heparin in the treatment of surgical patients with tumors complicated with disseminated intravascular coagulation

Objective To compare the effect and safety between microdose beparin and low - dose hepa- rin in the treatment of surgical patients with solid tumors complicated with disseminated intravaseular coagulation. Methods Fifty -eight cases with DIC were randomly divided into two group ：30 cases treated with microdosage heparin（group MMDH）,28 cases treated with low- dose heparin（group MLDH）. The miscoheparin group were pumped with heparin（ 10 -25 mg/d）continuously for 3 to 5 days ,and the low - dose heparin group were punmped with heparin（ 50 - 100 mg/d）continuously for 3 to 5 days too. Other therapeutic principle was the same in the two groups, PT, APTT, PLT, Fbg, D - D were observed in the two groups before the treatment and after the treatment; cure rate ,bleeding ,the length of stay in ICU ,the length of time of applying ventilator and the 28 - day case fatali- ty were recorded. Results In two groups, there were no significant differences in PT and APTT between pretreat- ment and post - teatment （ P 〉 0.05 ）. There were significant difference in other laboratory parameters （ P 〈 0.05 ） ; Cure rate of miseoheparin group and low - dose heparin were 46.7% and 21.4% , respectively. There was significantly different between the two groups （ P 〈 0.05 ） ; After pumping into heparin, 1 ease severely hemoyy- haged in the miseoheparin ,while the low-dose group were 7 cases. There was significantly different between the two groups（P 〈0.05） ;The length of stay in ICU and the length of time of applying ventilator in the miscooheparin were shorter than those in the low - heparin（ P 〈 0.01 ） , but there was no significant difference in the 28 - day case - fatality between the two groups （ P 〉 0.05 ）. Conclusion Using miseoheparin continuous transfusion reme-died surgical patients with solid tumors complicated with disseminated intravascular coagulation and could increase cure rate and effect ,and reduce bleeding and especially apply to the elderly patients and intraeerbral hem-orrhage.