低分子肝素对儿童脓毒症患者凝血功能及炎症因子的影响

姚桂爱 潜丽俊

[摘要] 目的 探討低分子肝素对儿童脓毒症患者凝血功能及炎症因子的影响。 方法 选取2013年10月～2017年10月儿童脓毒症患者68例，随机分为观察组与对照组，各34例。对照组患儿给予抗感染、液体复苏、营养支持和原发病治疗等基础治疗。观察组患儿在对照组基础上加用低分子肝素钠6000 U皮下注射，1次/12 h，连用7 d。观察两组患儿治疗前后血清凝血功能指标[凝血酶原时间（PT）、激活部分凝血酶原时间（APTT）、纤维蛋白原（FIB）和血小板（PLT）]和炎症因子[超敏C反应蛋白（Hs-CRP）、肿瘤坏死因子（TNF-α）和白介素（IL-6）]水平的变化，并比较其临床疗效。 结果 治疗7 d后，两组患儿PT、APTT明显下降，FIB和PLT明显上升（P<0.01或P<0.05），且观察组患儿下降或上升幅度更显著（P<0.05）；同时两组患者血清Hs-CRP、TNF-α和IL-6指标明显下降（P<0.01或P<0.05），且观察组下降幅度更显著（P<0.05）；观察组患儿临床总有效率较对照组更佳（χ2=4.20，P<0.05）。结论 儿童脓毒症患者予以低分子肝素治疗效果较佳，不仅能纠正凝血功能紊乱，而且能降低血清Hs-CRP、TNF-α和IL-6水平，能更有效地控制炎症反应过程。

[关键词] 脓毒症；儿童；低分子肝素；凝血功能；炎症因子

[中图分类号] R720.5 [文献标识码] A [文章编号] 1673-9701（2018）15-0001-03

Effect of low molecular weight heparin on blood coagulation and inflammatory factors in children with sepsis

YAO Guiai QIAN Lijun

Department of Pediatrics， Lishui Central Hospital in Zhejiang Province， Lishui 323000， China

[Abstract] Objective To investigate the effect of low molecular weight heparin on coagulation and inflammatory factors in children with sepsis. Methods 78 children with sepsis admitted in our hospital from October 2013 to October 2017 were randomly divided into observation group and control group， each group had 34 cases. Children in the control group were given anti-infection， liquid resuscitation， nutritional support， treatment of primary disease and other basic treatment. The children in the observation group took the same treatment as the control group and injected 6000 U low molecular weight heparin subcutaneously once every 12 h for 7 d. Serum coagulation parameters（prothrombin time （PT）， activated partial thromboplastin time（APTT）， fibrinogen （FIB） and platelet （PLT）] and inflammatory factors [hypersensitivity C reaction （Hs-CRP）， tumor necrosis factor（TNF-α）-alpha and interleukin（IL-6）] levels were measured and compared. Results After 7 days of treatment， PT and APTT in both groups were significantly decreased， FIB and PLT were significantly increased（P<0.01 or P<0.05）， and the decrease or increase in the observation group was more significant（P<0.05） The serum Hs-CRP， TNF-α and IL-6 index decreased significantly（P<0.01 or P<0.05）， and the decrease rate of the observation group was more significant（P<0.05）. The total clinical effective rate in the observation group was significantly higher than that in the control group（χ2=4.20， P<0.05）. Conclusion The treatment of low molecular weight heparin in children with sepsis shows better clinical therapeutic effect. It can not only correct the coagulation disorder， but also reduce the serum levels of Hs-CRP， TNF-α and IL-6 and control the inflammatory reaction more effectively.

[Key words] Sepsis； Children； Low molecular weight heparin； Coagulation； Inflammatory factor脓毒症是儿童重症监护室常见病，其病情危重，可引起弥漫性血管内凝血和多器官功能衰竭，其病死率约15%～28%[1，2]。脓毒症的致病机制尚不清楚，大多数学者认为脓毒症时凝血系统在炎性细胞、炎性因子和内毒素等作用下被激活，通过多种途径促进炎性反应发生，共同构成脓毒症发生发展过程，因此，凝血功能及炎症反应异常在其发病中起着极其重要的作用，抗凝治疗在兒童严重脓毒症治疗中起重要作用[3，4]。低分子肝素是一种常用的抗凝药物，逐渐在儿童脓毒症中应用，但其对凝血功能及炎症反应的影响鲜有报道[5，6]。本研究观察了低分子肝素对儿童脓毒症患者凝血功能及炎症因子的影响，现报道如下。

1 资料与方法