摘要
目的探讨脓毒症早期应用肝素钠的作用及其机制。方法将119例严重脓毒症患者按随机原则分为对照组（64例）和治疗组（55例）。两组基础治疗相同，治疗组于发生脓毒症后当日静脉泵入肝素钠2mg·kg^-1·d^-1；对照组则给予等量生理盐水。两组于治疗前及治疗1、3、5和10d检测血小板计数（PLT）、D-二聚体、血乳酸水平，观察活动性出血情况，并进行急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。结果除应用肝素钠外，两组患者感染和治疗情况以及APACHEⅡ评分差异无统计学意义（P均〉0．05）。治疗组活动性出血率显著低于对照组（12．5％比5．4％，P〈0．05）。治疗组PLT在治疗1d下降，3d开始回升，10d恢复到治疗前水平；对照组PLT在治疗1d后呈进行性减少（P〈0．05或P〈0．01）。治疗组D-二聚体在治疗1d显著上升（P〈0．01），3d即显著下降，恢复到治疗前水平；对照组D-二聚体在治疗1d显著上升，且持续增加至10d（P均〈0．01）。治疗组血乳酸水平在治疗1d显著上升（P〈0．01），但以后的各时间点未再显著增加（P均〉0．05）；对照组血乳酸水平在治疗1d显著上升，且持续增加（P均〈0．01）。治疗前及治疗1d两组PLT、D-二聚体、血乳酸水平差异均无统计学意义（P均〉0．05）；治疗组治疗3、5和10d PLT均显著高于对照组，D-二聚体、血乳酸水平均显著低于对照组（P〈0．05或P〈0．01）。结论在脓毒症发生早期即开始应用肝素钠，可显著抑制PLT减少以及D-二聚体和血乳酸水平上升，减少微血栓形成，改善组织灌注，降低活动性出血的风险。
Objective To assess the role of heparin administration in the early stage of sepsis and its mechanism of action. Methods This was a prospective study. One hundred and nineteen patients were enrolled in the study and were randomly divided into control group （64 cases） and therapy group （55 cases）. Except the basic therapy of sepsis given to patients in both groups, the patients in the control group received normal saline, while the patients in the therapy group received heparin 2 mg·kg^-1·d^-1 with the aid of intravenous pump continuously after the onset of sepsis. The platelet count （PLT）, D-dimer, and lactic acid in the blood were analyzed before therapy and on the 1st, 3rd, 5th and 10th day. The bleeding tendency was also observed. In every patient an acute physiology and chronic heath evaluation Ⅱ （APACHE Ⅱ ） score was made. Results Patients in both groups had a similar APACHE Ⅱ score. The pathogenetic and therapeutic condition were similar in both groups. The rate of the active bleeding in the therapy group was lower significantly than that of the control group （12.5% vs. 5.4%, P〈0.05）. The PLT of the therapy group decreased on the 1st day, but began to rise on the 3rd day gradually, and up to the same level of the admission day on the 10th day. The PLT of the control group decreased progressively every day （P〈0. 05 or P〈0.01）. D-dimer in the therapy group raised significantly on the 1st day, but lowered to normal level after 3 days. D-dimer in the control group went up progressively every day （all P〈0.01）. Lactic acid in the therapy group went up significantly on the 1st day （P〈0.01）, but it no longer rose after 3 days （all P〈 0. 05）. The lactic acid level in the control group rose progressively every day （all P〈0. 01）. There were no significant differences for the PLT, D-dimer, and lactic acid between the two groups before therapy and on the 1st day （all P〉0. 05）. However, on the 3rd, 5th and 10th day, the PLT in the therapy group was significant higher than that of the control group, the D-dimer and the lactic acid level in the therapy group were significantly lower than that of the control group （P 〈0.05 or P〈0.01）. Conclusion The use of heparin at the earlier period of sepsis can inhibit the lowering of PLT and increase of D-dimer and lactic acid significantly, prevent microvascular thrombosis, improve the tissue perfusion, and decrease active bleeding.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2008年第9期550-552,共3页
Chinese Critical Care Medicine
