| [Background]Sepsis is a systemic infection caused by inflammatory response syndrome, sepsis and the resulting multiple organ dysfunction syndrome (MODS) is a comprehensive cause of death among ICU patients, and many patients suffered combined coagulation abnormalities. Domestic and international researches have revealed high mortality of sepsis and the dysfunction of coagulation system is believed to be important in the onset and development of sepsis. Continuous blood purification (CBP) treatment for patients with sepsis and acute kidney injury (AKI) who have active bleeding or severe bleeding tendency requires heparin-free treatment to reduce the risk of bleeding. But scholars believe that the use of non-heparin anticoagulant therapy could possibly increase the consumption of coagulation factors and platelets, and therefore further aggrevate the blood coagulation dysfunction.[Objective]To study the effect and clinical outcome of CBP treatment with different anticoagulant ways to the coagulation function in patients with sepsis.[Methods]Seventy-five sepsis patients treated with CBP were divided into non-heparin group and the low molecular weight heparin group. The composition of the primary disease, site of infection, CVVH treatment dose and treatment time, and the course of treatment related to drug use in all the cases were studied. Before and24h,48h after treatment, the kidney function and anticoagulant function of these patients were analyzed. Twenty-four h and48h after treatment, changes in clinical indicators were analyzed for comparison of different time points and of the two groups.[Results]After CVVH treatment, the BUN, Cr of no heparin group and the low molecular weight heparin group were both decreased, but the change between groups was not statistically significant.The predicted mortality based on APACHE III before CVVH treatment of no heparin group was89.62±15.79%,and that of the low molecular weight heparin group was90.19±13.49%, the change between the two groups was not statistically significant. The28-day survival rate of no heparin group after treatment was38.46%while that of the low molecular weight heparin group was50%,and there was no statistically significant difference between the groups.After CVVH treatment, there was significant improvement in blood coagulation in both the no heparin group and the low molecular weight heparin group. The PLT value, PT values, APTT values, TT values, INR values and Fg values were lower than those of before treatment, but there was no statistical difference between the groups.[Conclusions]CBP treatment can effectively improve the clinical and biochemical indicators of sepsis in both the no heparin group and the low molecular weight heparin group. The treatment can also relieve the disease.Although there was no significance in the survival rate between the two groups, there was a trend of improvement in the survival rate. After CBP treatment, there was significant improvement in blood coagulation in both the no heparin group and the low molecular weight heparin group, but there was no statistical difference in the coagulation finction between the groups, indicading that the improvement of the coagulation system function by CBP treatment was not sole because of anticoagulant, and that CBP treatment without heparin did not increase blood coagulation dysfunction.The PLT value were lower than those of before treatment in both the no heparin group and the low molecular weight heparin group, but there was no statistical difference between the groups, suggesting that no heparin treatment did not necessarily increase the consumption of PLT. |
