潘毅+何飞民+孙贵才+夏芝辉+韩飚+闫智杰

[摘要] 目的 观察低分子肝素对脓毒症患者急性肾损伤的疗效及预后的影响。 方法 选取30例脓毒症合并肾损伤的患者，随机分为治疗组和对照组，对照组常规给予抗感染、呼吸支持、营养支持等治疗，治疗组给予低分子肝素针皮下注射，观察患者治疗后第3、7天肾功能胱抑素C（CysC）、血清肌酐（SCr）等的变化情况，并统计28 d生存率。 结果 治疗组患者治疗后第3、7天CysC水平与对照组比较，差异有统计学意义（P<0.01）；SCr治疗后第3天与对照组比较，差异无统计学意义（P>0.05），第7天与对照组比较，差异有统计学意义（P<0.05）；两组急性生理及慢性健康评分Ⅱ（APACHEⅡ评分）比较，差异无统计学意义（P>0.05）；治疗组生存11例，对照组生存9例；两组生存患者的CysC差异无统计学意义，而对照组死亡患者的CysC明显高于治疗组（P<0.05）。 结论 低分子肝素治疗脓毒症急性肾损伤，可减轻脓毒症肾损伤程度，改善肾功能，并在一定程度上影响预后。

[关键词] 脓毒症；肾损伤；低分子肝素

[中图分类号] R692 [文献标识码] A [文章编号] 1674-4721（2014）09（a）-0069-03

Curative effect evaluation on low molecular heparin in sepsis patients with acute kidney injury

PAN Yi HE fei-min SUN Gui-cai XIA Zhi-hui HAN Biao YAN Zhi-jie

Intensive Care Unit，the Fourth Affiliated Hospital of Nanchang University，Nanchang 330003，China

[Abstract] Objective To observe the effect and prognostic impact of low molecular heparin in sepsis patients with acute kidney injury. Methods 30 cases of sepsis patients with combined renal injury were selected and randomly divided into treatment group and control group，the control group was given routine anti-infection，respiratory support，and nutritional support treatment，the treatment group was given low molecular heparin subcutaneous injection needle，the change of renal function cystatin C （CysC），serum creatinine （SCr） so on in 3 and 7 days after treatment were observed，the survival rate of 28 days were counted. Results The CysC level in in 3 and 7 days after treatment of treatment group compared with the control group，the difference was statistically significant （P<0.01），but the SCr in 3 days after treatment compared with the control group，there was no statistically significant difference （P>0.05），the 3 days after treatment compared with the control group，the difference was statistically significant （P<0.05）.The acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ score） between the two groups，there was no statistically significant difference （P>0.05）.The treatment group survival in 11 cases，9 cases in control group，the CysC in survival patients of two groups with no statistical significance，while the CysC in death patients of control group was significantly higher than that of treatment group （P<0.05）. Conclusion Low molecular heparin in the treatment of sepsis patients with acute renal injury can reduce sepsis renal damage degree，and improve renal function and to a certain extent affect the prognosis.

[Key words] Sepsis；Kidney injury；Low molecular heparinendprint

脓毒症是感染引起的全身炎症反应综合征，往往导致多器官功能受损，其中肾脏是最常受累的器官之一。有研究报道，脓毒症合并急性肾损伤（acute kidney injury，AKI）住院病死率明显高于非脓毒症合并AKI（70.2%∶51.8%）[1]，因此，AKI被认为是能预测患者死亡的独立危险因素。由于脓毒症的病理生理机制比较复杂，根据相应机制有较多治疗方面的研究，本研究主要观察低分子肝素对脓毒症急性肾损伤患者的治疗效果及可能的机制，以为临床提供参考。

1 资料与方法

1.1 一般资料

选择2013年6～12月在本院综合ICU住院的脓毒症患者30例，其中男17例，女13例，急性生理及慢性健康评分Ⅱ（APACHEⅡ评分）≥15分；基础疾病：慢性阻塞性肺疾病（COPD）6例、重症肺炎12例、脑血管意外8例及外科术后4例。……