低分子肝素治疗脓毒症的前瞻性临床研究
艾宇航 张丽娜 龚华 徐道妙 赵双平 陈江辉【摘要】 目的 探讨低分子肝素对脓毒症的治疗作用。方法 40例脓毒症患者随机分为常规治疗组和低分子肝素治疗组。观察两组患者治疗前后急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、住重症监护治疗病房(ICU)时间和28 d病死率差异，以及治疗前后白细胞介素-6(IL-6)、丙二醛(MDA)、超氧化物歧化酶(SOD)、凝血功能和血小板计数(PLT)变化。结果 低分子肝素治疗组随治疗时间的延长，APACHEⅡ评分和IL-6水平均下降，治疗后7 d与治疗前比较差异均有显著性(P均<0.05)；而常规治疗组呈现先降后升的趋势；治疗后7 d低分子肝素治疗组APACHEⅡ评分和IL-6水平均明显低于常规治疗组(P均<0.05)。低分子肝素治疗组住ICU时间为(9.92±6.81)d，28 d病死率为40.9%，均低于常规治疗组(12.85±9.14)d和50.0%，但差异无显著性。低分子肝素治疗组治疗后SOD明显升高〔(159.13±99.31)kU/L比(318.38±254.29)kU/L〕，MDA明显下降〔(17.72±14.89)μmol/L比(6.62±5.53)μmol/L〕；常规治疗组则均呈相反的变化趋势〔SOD(180.99±169.40)kU/L比(135.16±107.73)kU/L；MDA(17.25±15.74)μmol/L比(20.77±16.87)μmol/L〕；治疗后两组比较差异均有显著性(P均<0.05)。两组患者凝血酶原时间(PT)、白陶土部分凝血酶原时间(KPTT)、纤维蛋白原(FIB)、PLT水平治疗前后差异均无显著性。结论 低分子肝素治疗脓毒症可抑制炎性介质和氧自由基的释放，临床应用安全，无严重并发症。
【关键词】 低分子肝素； 脓毒症； 白细胞介素-6； 丙二醛； 超氧化物歧化酶
Clinical study of low molecular weight heparin therapy for sepsis AI Yu-hang, ZHANG Li-na, GONG Hua, XU Dao-miao, ZHAO Shuang-ping, CHEN Jiang-hui. Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
【Abstract】 Objective To investigate the therapeutic effect of low molecular weight heparin (LMWH) therapy on sepsis. Methods Forty sepsis patients were randomly divided into two groups: routine treatment group and LMWH treatment group. Score of acute physiology and chronic health evaluationⅡ (APACHEⅡ), the days in intensive care unit (ICU) and mortality rate in 28 days were observed, and the levels of interleukin-6 (IL-6), malondialdehyde (MDA), superoxide dismutase (SOD), coagulation function and platelet count (PLT) were determined before and after treatment in the two groups. Results Both APACHEⅡ and IL-6 levels in LMWH group decreased with passage of time, the differences were significant between the results on day 7 and that of pretreatment (both P<0.05). In the routine treatment group, APACHEⅡ and IL-6 levels decreased first and then increased, and they were higher than those in LMWH group 7 days after treatment (both P<0.05). In LMWH group, the time of stay in ICU was (9.92±6.81)days, the mortality rate in 28 days was 40.9%, and they all were lower than those in routine treatment group 〔(12.85±9.14)days and 50.0%〕, but the difference was not statistically significant (both P>0.05). After treatment SOD level elevated 〔(159.13±99.31) kU/L vs.(318.38±284.29)kU/L〕 and MDA level lowered 〔(17.72±14.89) μmol/L vs.(6.62±5.53) μmol/L〕 in LMWH group. The changes in MDA and SOD in routine treatment were reverse to those of the LMWH group 〔SOD:(180.99±169.40) kU/L vs. (135.16±107.73) kU/L; MDA: (17.25±15.74) μmol/L vs.(20.77±16.87)μmol/L〕. The difference was significant between the two groups after treatment (both P<0.05). The difference in coagulation function and PLT was not significant between the two groups. Conclusion LMWH can ameliorate sepsis by down-regulating the levels of pro-inflammatory cytokines, and suppressing the release of oxygen-derived free radicals. It is a promising treatment measure in sepsis patient with safety and no severe side effects. ......
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