抗凝在脓毒症休克治疗中的疗效观察

唐铭　张晓静　张曼卡　许天琪　薛晓艳

【摘要】 目的：观察抗凝在脓毒症休克治疗中的疗效。方法：选取航天中心医院综合ICU、老年科及急诊ICU收治的90例脓毒症休克患者，分为低分子肝素治疗组32例、普通肝素治疗组22例和对照组36例。对照组给予常规治疗;治疗组在对照组基础上给予低分子肝素或普通肝素治疗。比较三组患者各项临床相关指标。结果：低分子肝素组治疗后7d与对照组治疗后7d相比，白细胞显著下降，差异有统计学意义（P<0.05）;普通肝素组治疗后7d与低分子肝素组治疗后7d相比，血小板显著下降，差异有统计学意义（P<0.05）;低分子肝素组及普通肝素组治疗前与对照组相比，D-二聚体显著升高，差异有统计学意义（P<0.05）;三组凝血指标（PT、APTT、FIB）治疗前后差异均无统计学意义（P>0.05）。结论：低分子肝素能够改善脓毒症休克患者炎症指标;普通肝素能够诱导脓毒症休克患者血小板减少;抗凝治疗能够改善脓毒症休克患者微循环障碍。

【关键词】 脓毒症休克;抗凝;普通肝素;低分子肝素

【中图分类号】R248 【文献标志码】B 【文章编号】1005-0019（2020）12-270-01

Therapeutic effects of anticoagulant therapy in patients with septic shock

Tang Ming，Zhang Xiao-jing，Zhang Man-ka，Xu Tian-qi，Xue Xiao-yan

（Aerospace Central Hospital，Intensive Care Unit，Beijing，100049）

Abstract：Objective To investigate the therapeutic effects of anticoagulant therapy in patients with septic shock. Methods：90 patients with septic shock in general ICU，geriatrics department and emergency ICU of Aerospace Center Hospital were divided into low molecular weight heparin treatment group （32 cases），unfractionated heparin treatment group （22 cases） and control group （36 cases）. The control group was given conventional treatment; the treatment group was given low molecular weight heparin or unfractionated heparin on the basis of the control group. The clinical indexes of the three groups were compared.Results：The white blood cell treated with LMWH after 7d decreased significantly compared with control group（P<0.05）;the platelet treated with UFH after 7d decreased significantly compared with LMWH group（P<0.05）;the D-dimer before treatment in LMWH and UFH groups raised significantly compared with control group（P<0.05）; no significant difference were found with PT、APTT、FIB in three groups. Conclusion：LMWH can improve the inflammatory biomarkers of patients with septic shock; UFH can induce the platelet decreased of patients with septic shock; anticoagulant can improve the microcirculation disturbance of patients with septic shock.

Key words：Septic shock; Anticoagulation; Unfractionated heparin （UFH）; low-molecular-weight heparin （LMWH）

隨着社会的进步、医疗的发展，人们对消毒和无菌有了前所未有的重视，但脓毒症仍然是世界范围内的主要死亡原因，发病率在75-300/10万之间[1]。众所周知，脓毒症的死亡率居高不下，仅脓毒症的死亡率就高达25%，但如果伴有器官衰竭，死亡率会翻倍。脓毒症经充分容量复苏后仍存在低血压即为脓毒症休克。在国内，脓毒症和脓毒症休克病死率高达30%-70%[2]，鉴于脓毒症休克的高发病率、高死亡率及高花费，如何有效的控制感染及逆转休克成为当今医疗界必需面对的棘手问题之一。众所周知，脓毒症的发生伴随着凝血系统的激活，同时会伴有纤溶和抗凝系统的损伤。关于脓毒症及脓毒症休克患者是否需要抗凝治疗，国际专家学者各持不同意见。……