微剂量肝素治疗恶性血液病并发弥散性血管内凝血28例疗效观察

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1、微剂量肝素治疗恶性血液病并发弥散性血管内凝血28例疗效观察【关键词】肝素摘要：目的：探讨肝素治疗恶性血液病并发弥散性血管内凝血（DIC）合适的剂量。方法：对55例DIC患者，按原发病、DIC分期、分型随机分为观察组28例和对照组27例。观察组：用微剂量肝素15mg/d分三次静滴，对照组：急性型DIC和亚急性型DIC分别用小剂量肝素90mg/d和48mg/d分三次静滴；两组病例用肝素抗凝治疗3～7d，抗凝期间用凝血时间试管法（CT）进行监测。结果:观察组有效率60.7%（17/28例），其中急性型DIC有效率为60%（9/15例），明显高于对照组

2、急性型DIC疗效（3/14例，有效率21.4%，p＜0.05,应用微剂量肝素抗凝期间,CT保持在21～27min，无肝素引起的出血倾向加重等肝素副作用。对照组有效率44.4%（12/27例），在小剂量肝素抗凝期间，有5例CT时间达到32～34min并有出血倾向加重等肝素副作用。结论：微剂量肝素是治疗恶性血液病并发的DIC合适的抗凝剂量，对急性型DIC疗效明显高于小剂量肝素，安全性高，不加重出血倾向。关键词：DIC；恶性血液病；微剂量肝素Micro-DoseHeparinIntheTreatmentof28CasesHematologicMali

3、gnancieswithDessiminatedIntravascularCoagulation7Abstract:Objective:Toexploretheproperdoseofheparintherapyinhematologicmalignanciesdiseasewithdessiminatedintravascularcoagulation(DIC).Method:Fifty-fivecasesofDICweredividedrandomlyintotwogroups(Theobservedgroupandthecontrolgr

4、oup)bythetypeandtheperiodofDICandprimaryaffection.Themicrodoseheparingroup(Theobservedgroup,28cases);heparininfusioninmicrodose(15mg/d).Thelow-doseheparingroup(Thecontrolgroup,27cases):lowdoseheparininfusion(90mg/dinacutetypeofDICand48mg/dinsubacutetypeofDIC).Heparininfusion

5、3～7dinallthecasesandobservetheclottingtimebytubemethodduringtheheparintherapy.Result:Theobservedgroup60.7%（17/28cases）waseffectiveinallthepatientswhile60%(9/15cases)waseffectiveintheacutetypeofDIC,theeffectiveratewasmorehigherinacutetypeofDICthanthecontrolgroup(3/14cases,eff

6、ectiveratewas21.4%,p＜0.05）andtheclottingtimein21～27minuteswithnonehaemorrhagictendencybyheparintherapy.Thecontrolgroup44.4%(12/27cases)waseffectiveinallthepatients,clottingtimebytubemethodin5caseswasdelayedto32～34minutesandwithhaemorrhagictendencyduringtheheparintherapy.Conc

7、lusion:Heparinanti-coagulation.Therapyin7hematologicmalignancieswithDIC,micro-doseofheparinissuitableforacutetypeofDIC,micro-doseheparinrevealedahigherefficacyandsafetyincomparisonwiththelow-doseheparinwithlesshaemorrhagictendency.Keywords:DIC;Hematologicmalignancies;Micro-d

8、oseheparinDIC是恶性血液病常见的并发症，起病突然，病死率高；应用肝素抗凝治疗是终止DIC病理过程，降低病死率的有效措施之一。为了探索适合恶