低分子肝素对肺炎合并脓毒症患者凝血和内皮细胞功能的影响

张天翼　卢艳萍　余方宇

[摘要] 目的 探討低分子肝素对肺炎合并脓毒症患者凝血和内皮细胞功能的影响。 方法 选取2013年1月～2017年7月肺炎合并脓毒症患者患者70例，随机分为观察组和对照组。两组均予液体复苏、抗感染、血管加压药、营养支持、血糖控制、脏器支持及预防应激性溃疡等治疗，必要时予以机械通气支持治疗。观察组加用低分子肝素0.6 mL皮下注射，2次/d，连用7 d。观察并记录两组治疗前后凝血功能指标[凝血酶原时间（PT）和激活部分凝血酶原时间（APTT）]及内皮功能指标[血清血管性假血友病因子（vWF）和内皮细胞特异性分子1（ESM-1）]的变化，并评估其临床效果。 结果 治疗7 d后，两组PT和APTT指标与治疗前比较均有不同程度下降（P<0.05或P<0.01），且观察组下降幅度较对照组更显著（P<0.05）；两组vWF和ESM-1指标与治疗前比较均有不同程度下降（P<0.05或P<0.01），且观察组下降值较对照组更显著（P<0.05）；同时观察组临床总有效率较对照组更高（χ2=4.20，P<0.05）。 结论 低分子肝素用于肺炎合并脓毒症患者的效果较肯定，不仅可改善其凝血功能，而且可修复血管内皮细胞功能。

[关键词] 脓毒症；肺炎；低分子肝素；凝血功能；内皮细胞功能

[中图分类号] R722 [文献标识码] B [文章编号] 1673-9701（2018）12-0045-03

Influence of low molecular heparin on coagulation and endothelial cell function of patients with pneumonia combined with pyemia

ZHANG Tianyi1 LU Yanping1 YU Fangyu2

1.Department of Respiration， Luqiao Hospital of Taizhou Enze Medical Center（Group），Taizhou 318050，China； 2.Emergency Ward，Luqiao Hospital of Taizhou Enze Medical Center（Group），Taizhou 318050，China

[Abstract] Objective To discuss the influence of low molecular heparin on coagulation and endothelial cell function of patients with pneumonia combined with pyemia. Methods 70 cases of patients with pneumonia combined with pyemia from January 2013 to July 2017 were divided into observation group and control group at random. The patients in two groups were given fluid resuscitation， anti-infection， vasopressor， nutrition support， control of blood sugar， organsupport， prevention of stress ulcer， and mechanical ventilatory support if necessary， and the patients in observation group were additionally given 0.6 mL low molecular heparin by hypodermic injection， twice a day， for 7 days. The changes of coagulation function indexes [prothrombin time（PT） and activated partial thrombin time（APTT）] and endothelial cell function indexes[serum von Willebrand factor（vWF） and Endothelial cell specific molecule-1 （ESM-1）] in two groups were observed before and after treatment， and the clinical curative effect was evaluated as well. Results After 7 days treatment， the PT and APTT indexes in two groups were declined than before at different degrees （P<0.05 or P<0.01）， and the declining rates in observation group were much higher than those in control group（P<0.05）. The vWF and ESM-1 indexes in two groups were declined than before at different degrees（P<0.05 or P<0.01）， and the declining rates in observation group were much higher than those in control group（P<0.05）. Meanwhile， the total clinical efficiency in observation group was much higher than that in control group （χ2=4.20，P<0.05）. Conclusion The low molecular heparin has reliable curative effect on patients with pneumonia combined with pyemia，which can improve the coagulation function and repair the endothelial cell function as well.

[Key words] Pyemia； Pneumonia； Low molecular heparin； Coagulation function； Endothelial cell function

脓毒症是一种全身炎症反应综合征，病情较危重，进展快，可诱发脓毒症休克、弥散性血管内凝血和多器官功能障碍，病死率高达30%左右，在所有引起脓毒症的病因中，肺炎占大部分[1，2]。肺炎合并脓毒症的发病机制较复杂，除炎症因子外，凝血功能活化及内皮功能受损在其发病中的作用也越来越受到临床的重视[3，4]。低分子肝素是经肝素降解所得的低分子量片段，近年来用于脓毒症的治疗中取得了较好的疗效，但其对凝血指标和血管内皮功能的影响国内外鲜有报道[5，6]。本研究探讨了低分子肝素对肺炎合并脓毒症患者凝血和内皮细胞功能的影响，现报道如下。……