摘要
目的探讨MODS患者凝血系统的变化及山莨菪碱对其凝血异常的影响。方法46例MODS患者随机分为A、B两组,A组为常规治疗组,B组在常规治疗的基础上加用山莨菪碱,观察治疗前及治疗第4、7天的APACHEⅡ评分及Mar shall评分和凝血指标包括凝血酶原时间(PT)、部分激活的凝血酶原时间(APTT)、凝血酶时间(TT)、抗凝血酶Ⅲ(AT-Ⅲ)、血小板计数(PLT)及血浆D-二聚体(D-D)情况,对其变化趋势进行分析,20名健康成人作对照组。结果治疗前所有入选MODS患者均存在凝血异常,表现为APTT、PT、TT延长(P<0.01),AT-Ⅲ活性下降(P<0.01),血浆D-D明显升高(P<0 01),血小板计数下降(P<0.01);经治疗后两评分水平均改善,同时APTT、PT、TT逐渐趋于正常,AT-Ⅲ活性恢复,血小板计数回升,D-D明显下降,所有改变均以B组明显,且第4天时即已表现出明显变化。结论MODS患者存在凝血异常,该异常主要表现为凝血、纤溶激活而抗凝抑制,山莨菪碱能使MODS患者的凝血异常改善。
Objective To investigate the changes of MODS patients′ coagulation system and the effect of anisodamine on the MODS patients′ coagulation abnormalities.Methods 46 MODS patients accepted either standard treatment or additional anisodamine and were divided into two groups (A:routine treatment group, B:the control group) at random. The levels of prothrombin time(PT),activated partial thromboplastin time (APTT),thrombin time(TT),fibrinogen(FIB),antithrombinⅢ(AT-Ⅲ) and D-dimer(D-D) were measured in all the patients at the 0 and 4th, 7th day.At the same time the APACHEⅡ and Marshall score were measured. 20 health adults were regarded as the control group.Results Before treatment the levels of PT,APTT and TT of all the patients were longer,D-D were higher but AT-Ⅲ and PLT were lower in the routine treatment group than in control group.After treatment the score of APACHEⅡ and Marshall were decreased.The time of PT,APTT,TT all tended to normalize; AT-Ⅲ and PLT were increased ;D-D was decreased. Compared with A group, B group changed more significantly,and the changes were significant on the 4th day.Conclusions MODS patients have coagulation abnormalities,which were characterized by procoagulant and fibrinolytic activation and anticoagulant inactivation. Anisodamine can improve MODS patients′ this abnormalities. [
出处
《中国急救医学》
CAS
CSCD
北大核心
2005年第4期255-257,共3页
Chinese Journal of Critical Care Medicine
