马晓红 欧远贵 覃艺 封华海

【摘要】 目的 探讨小剂量肝素治疗儿童重症水痘并脓毒症的临床疗效和安全性。方法 选取2019年1月至2022年12月收治的51例重症水痘并脓毒症患儿的临床资料，根据是否使用小剂量肝素治疗分为研究组28例与对照组23例，入院后两组患儿均予针对病因、脏器支持等综合治疗，研究组同时加用小剂量肝素辅助治疗，比较两组小儿危重症评分（PCIS）、凝血功能指标、PLT水平、弥散性血管内凝血（DIC）和多脏器功能障碍（MODS）的发生率以及住院时间。结果 治疗后研究组与对照组比较，D-二聚体水平显著下降，APTT、PT显著缩短，PLT水平显著升高，差异均有统计学意义（P<0.05）；研究组FIB高于对照组，但差异无统计学意义（P＞0.05）；研究组DIC和MODS发生率分别为17.9%和14.3%，明显低于对照组的43.4%和39.1%，两组比较差异有统计学意义（P<0.05）；研究组住院时间短于对照组，PCIS评分高于对照组，两组比较差异有统计学意义（P<0.05或0.001）。结论 儿童重症水痘并脓毒症伴有凝血功能障碍时应用小剂量肝素治疗，可改善凝血功能，保护脏器功能，降低DIC及MODS的发生率，缩短住院时间，改善临床预后，且不增加出血风险，值得临床推广应用。

【关键词】 水痘；儿童；脓毒症；小剂量肝素；凝血功能障礙

中图分类号：R725.1 文献标志码：A DOI：10.3969/j.issn.1003-1383.2023.05.007

【Abstract】 Objective To investigate the clinical efficacy and safety of low-dose heparin in the treatment of severe varicella complicated with sepsis in children.Methods The clinical data of 51 children with severe varicella complicated with sepsis admitted to Red Cross Hospital of Yulin City from January 2019 to December 2022 were selected and divided into study group （28 cases） and control group （23 cases） based on whether they were treated with low-dose heparin. After admission， the two groups of children were given comprehensive treatment such as etiology and organ support， and based on which， the study group were given adjuvant treatment with low-dose heparin. And then， pediatric critical illness score（PCIS）， coagulation function indicators， PLT levels， incidence of disseminated intravascular coagulation （DIC） and multiple organ dysfunction syndrome （MODS）， and length of stay were compared between the two groups.Results After treatment， compared with the control group， the D-dimer level in the study group decreased， APTT and PT prolonged， and PLT level increased significantly， and difference was statistically significant （P<0.05）; the FIB of the study group was higher than that of the control group， but the difference was not statistically significant （P>0.05）; the incidence of DIC and MODS in the study group was 17.9% and 14.3%， respectively， significantly lower than that in the control group（43.4% and 39.1%）， and difference was statistically significant between the two groups （P<0.05）; the length of stay of the study group was shorter than that of the control group， and the PCIS score was higher than that of the control group， and the difference between the two groups was statistically significant （P<0.05 or 0.001）.Conclusion For children with severe chickenpox and sepsis accompanied by coagulation dysfunction， low-dose heparin can improve coagulation function， protect organ function， reduce the incidence of DIC and MODS， shorten the length of hospital stay， and improve clinical prognosis without increasing the risk of bleeding， and thus， it is worthy of promotion and application in clinical practice.

【Key words】 varicella; sepsis; low-dose heparin; coagulation disorders

水痘（varicella）是儿童常见的一种传染性极强的出疹性疾病，主要是由水痘-带状疱疹病毒感染引起，传染性极强，易感人群在90%以上，尤其儿童最敏感。水痘多为自限性疾病，大部分水痘患者预后良好，但当患儿合并免疫抑制或继发严重细菌感染时，可发展为重症水痘伴随脓毒症［1］，如不及时识别和救治，容易合并弥散性血管内凝血（DIC）、多脏器功能障碍（MODS）及脓毒性休克等严重并发症，病死率高。危重症水痘的预后与脓毒症的发生和发展密切相关［2］，而脓毒症相关性凝血功能障碍是导致器官功能障碍或衰竭的重要因素，成为影响脓毒症患者预后的重要并发症。早期诊断脓毒症相关性凝血功能障碍，启动及时有效的抗凝治疗可改善预后。……