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目的评价低分子肝素对脓毒症患儿凝血功能改善的疗效。方法将2007年1月至2008年1月首都儿研所附属儿童医院ICU诊断的脓毒症患儿24例,随机分为低分子肝素治疗组和对照组各12例。监测两组患儿的血小板(PLT)计数、凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、纤维蛋白原(Fbg)、D-二聚体(D-dimer)、纤维蛋白降解产物(FDP)和凝血酶-抗凝血酶复合物(TAT)、蛋白C(PC)、蛋白S(PS)和抗凝血酶-Ⅲ(AT-Ⅲ),并进行危重程度评分。结果脓毒症患儿治疗后的PC、PS均较治疗前升高,肝素治疗组和对照组比较差异有统计学意义(P<0.01);两组患儿治疗后TAT较治疗前均明显下降,治疗组下降幅度大于对照组,但差异无统计学意义(P>0.05);治疗2d,两组患儿危重评分均有升高,治疗组升高较对照组明显,差异有统计学意义(P<0.05)。结论低分子肝素治疗可有效改善脓毒症患儿的出凝血功能紊乱,小剂量应用无明显出血的副反应。
Objective To evaluate the effect of low molecular weight heparin on the improvement of coagulation in children with sepsis. Methods From January 2007 to January 2008, 24 children with sepsis diagnosed by ICU of Children’s Hospital affiliated to Capital Institute of Pediatrics were randomly divided into low molecular weight heparin treatment group and control group, 12 patients each. Platelet count (PLT), prothrombin time (PT), partial activated thromboplastin time (APTT), fibrinogen (Fbg), D-dimer, (FDP), thrombin-antithrombin complex (TAT), protein C (PC), protein S (PS) and antithrombin-Ⅲ (AT-Ⅲ) were measured and scored. Results The PC and PS in children with sepsis were significantly higher than those before treatment, and there was significant difference between the heparin group and the control group (P <0.01). The TAT in both groups were significantly decreased after treatment , The treatment group decreased more than the control group, but the difference was not statistically significant (P> 0.05); 2d after treatment, the two groups of children’s risk score were increased, the treatment group increased more significantly than the control group, the difference was statistically significant P <0.05). Conclusion Low molecular weight heparin treatment can effectively improve the coagulation disorders in children with sepsis, low-dose application without obvious side effects of bleeding.