The Clinical Studies Of Argatroban Used In Surgical Postoperative Severe Sepsis

Objective:To observe argatroban used in surgical postoperative severe sepsis with thrombocytopenia (PLT<30×109/L) of anticoagulant therapy in patients with curative effect, discusses its medication safety.Methods:Collected in January 2015-March 2016 revenue in the second affiliated hospital of kunming medical university during intensive medicine (ICU) in line with the diagnostic criteria of surgical postoperative severe sepsis with thrombocytopenia (PLT<30×109/L) of anticoagulant therapy in patients with 25 cases (group B).They underwent resuscitation through early goal-directed therapy.Observed using argatroban coagulation indexes before and after anticoagulant therapy, PLT, HB and DIC score, APACHE II score, SOFA score changes. Collected at the same time in the same period in the use of ICU low molecular heparin anticoagulation therapy after the surgery patients with severe sepsis (group A). Compare two groups of blood coagulation indexes before and after anticoagulant therapy, PLT, HB and DIC score, APACHE II score, SOFA score changes, recording time of mechanical ventilation, ICU time, hemorrhagic complications, blood transfusion, blood transfusion amount, 28 days case fatality rate. Record argatroban use dosage and adjust.Results:1. Low molecular heparin group (group A) and argatroban group (group B) piece of general situation, primary disease, DIC score before treatment, SOFA score and APACHE II score had no statistical difference (P>0.05).2. Low molecular heparin group (group A) and argatroban group (group B) patients with HB, PT, FIB before treatment, treatment 1,2,3,5,7 days no statistically significant difference (P> 0.05). Group B after treatment 2,3,5,7 days FIB value was higher, the difference was statistically significant compared with before treatment (P< 0.05).3. Low molecular heparin group (group A) and argatroban group (group B) patients before treatment, treatment 1,2,3 days PLT than obvious difference (P< 0.05), argatroban group is lower than low molecular heparin group (group A), two groups of PLT were rising trend, treatment,5,7 days no statistically significant differences between the two groups (P> 0.05). Group B after treatment 2,3,5,7 days PLT higher than before treatment, compared with before treatment, the difference was statistically significant (P< 0.05).4. Low molecular heparin group (group A) and argatroban group (group B) patients before treatment, APTT, TT compared with no significant difference (P> 0.05), treatment group B, APTT, TT is extend the trend. Compared with before treatment, the difference was statistically significant (P< 0.05), compared with group A, the difference was statistically significant (P< 0.05).5. Low molecular heparin group (group A) and argatroban group (group B) patients before and after treatment the AT-Ⅲ compared with no significant difference (P>0.05). But two groups of anticoagulant therapy after the start, the AT-Ⅲ are on the rise, group B treatment of 3,5, and 7 days was obviously higher, the difference was statistically significant (P< 0.05).6. Low molecular heparin group (group A) and argatroban group (group B) patients before treatment, treatment 1,2 days no difference between the two groups of DD values (P> 0.05), but the DD values are falling, the two groups treatment group B on day 3,5, and 7 more apparent, compared with group A, the difference was statistically significant (P< 0.05), compared with before treatment, the difference was statistically significant (P< 0.05).7. Low molecular heparin group (group A) and argatroban group (group B) after anticoagulation (d7) SOFA score and APACHE Ⅱ score, DIC score and mechanical ventilation time and ICU length of hospital stay,28 d case fatality rate had no statistical difference (P> 0.05); Group B (d7) after anticoagulation SOFA score, APACHE Ⅱ score, DIC score was (d0), the difference was statistically significant (P<0.05)8. Low molecular heparin group (group A) after anticoagulation in 3 patients (PLT<30 x 109/L) in surgical wound drainage and seepage.9. According to different SOFA scoring system, liver function grade, argatroban dose was statistically difference (P< 0.05).Conclusion:1. Argatroban can improve surgical postoperative severe sepsis with thrombocytopenia in patients with blood coagulation dysfunction, can reduce the SOFA score and APACHE Ⅱ score, DIC score.2. Surgical postoperative severe sepsis with thrombocytopenia (PLT≤30 x 109/ L)patients using Argatroban anticoagulant therapy is safe.3. Argatroban anticoagulation is not affected by the level of antithrombin, may also merge the AT-Ⅲ decrease anticoagulant treatment in patients with sepsis is better.4. Argatroban dose adjustments may refer to patients with liver function score ratings system (SOFA), PT, APTT and dynamic.5. Argatroban for surgical postoperative severe sepsis with thrombocytopenia (PLT≤30 × 109/L) in patients with anticoagulant dosage below documents recommended HIT patients (2-2.5 ug/kg, min -1), this study recommended dosage is 0.1 to 1.8ug/(kg/min).