| 贺志高,肖凌,陶文,蒋普,李静,唐姗姗,陈琳.基于DIC评分早期分层抗凝对改善脓毒症预后的有效性和安全性研究.[J].中南医学科学杂志.,2023,(3):414-417. |
| 基于DIC评分早期分层抗凝对改善脓毒症预后的有效性和安全性研究 |
| Effectiveness and safety of early stratified anticoagulation based on DIC score in improving prognosis of sepsis |
| 投稿时间：2022-10-07 修订日期：2023-02-20 |
| DOI：10.15972/j.cnki.43-1509/r.2023.03.024 |
| 中文关键词: 脓毒症 弥散性血管内凝血 抗凝治疗 临床效果 [ |
| 英文关键词:sepsis disseminated intravascular coagulation anticoagulant therapy clinical effect |
| 基金项目:重庆市科卫联合医学科研项目(2020MSXM084) |
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| 中文摘要: |
| 目的探讨基于弥散性血管内凝血(DIC)评分早期分层抗凝对改善脓毒症预后的有效性和安全性。 方法选取脓毒症患者265例,根据DIC和SIC评分分组,将患者分为DIC组84例、脓毒症凝血病(SIC)组92例和对照组84例(正常凝血状态)。其中DIC组给予常规剂量低分子肝素抗凝治疗,SIC组给予半量低分子肝素治疗,对照组不给予抗凝等治疗。 结果DIC组ICU住院时间、呼吸机使用时间和总住院时间较对照组延长(P＜0.05)；28天病死率比较,DIC组、SIC组和对照组差异无统计学意义(P＞0.05)。DIC组、SIC组治疗后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和D二聚体(D-Dimer,D-D)低于治疗前,且DIC组高于SIC和对照组(P＜0.05),而血小板和纤维蛋白原(FIB)低于SIC组和对照组(P＜0.05)。DIC组、SIC组和对照组治疗后乳酸、BUN和Scr均较治疗前降低,DIC组仍高于SIC组和对照组(P＜0.05)。治疗后急性生理及慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)评分均较治疗前降低,SIC组评分低于对照组,DIC组APACHEⅡ评分高于SIC组和对照组(P＜0.05)。DIC组、SIC组和对照组出血事件总发生率差异无显著性(P＞0.05)。 结论基于脓毒症DIC评分早期分层抗凝在脓毒症治疗中有较好的效果,可减轻患者凝血功能和脏器损功能损害。 |
| 英文摘要: |
| AimTo explore the efficacy and safety of early stratified anticoagulation based on sepsis disseminated intravascular coagulation (DIC) score in improving the prognosis of sepsis. Methods265 patients with sepsis were selected and grouped by envelope method, the patients were divided into septic DIC group 89 cases, septic coagulation disease (SIC) group 92 cases and control group 84 cases, the DIC group received conventional dose of low molecular weight heparin anticoagulation therapy, while the SIC group received half dose of low molecular weight heparin therapy, the control group was not given anticoagulant treatment. ResultsThe ICU hospitalization time, ventilator use time and total hospitalization time in the DIC and SIC group were significantly longer than those in the control group (P＜0.05). There was no significant difference in the 28 day mortality between the DIC, SIC group and the control group (P＞0.05). The prothrombin time (PT), activated partial thromboplastin time (APTT) and D-Dimer of DIC and SIC group after treatment were significantly lower than before (P＜0.05), moreover higher in DIC group than that in SIC and control group, while the level of platelet and fibrinogen of DIC group were significantly lower than that of SIC and control group (P＜0.05). After treatment, lactate, BUN, and Scr decreased compared to before treatment, and the DIC group was still higher than the SIC group and control group (P＜0.05). Acute Physiological and Chronic Health Score Ⅱ after Treatment (APACHE Ⅱ). The scores and Sequential Organ Failure Score (SOFA) decreased compared to before treatment. The score in the SIC group was lower than that in the control group, while the APACHE II score in the DIC group was higher than that in the SIC group. And the control group (P＜0.05). There was no significant difference in the total incidence of bleeding events between the DIC group, SIC group and control group (P＞0.05). ConclusionEarly stratified anticoagulation based on sepsis DIC score has a good effect in sepsis treatment, and significantly improves the coagulation function and renal function of patients. |
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