Clinical Effect Of Low Molecular Weight Heparin In The Treatment Of Sepsis

Objective: Observe the clinical effect of LMWH in the treatment of sepsis,and evaluate its effect on coagulation function,inflammatory index and prognosis.Methods: Selected 116 patients who were diagnosed as sepsis from 2013 June to 2017 May in Tianjin Hospital ICU and Tianjin 1st Central Hospital ICU.The primary disease included 82 cases of severe pneumonia,17 cases of abdomen infections,14 cases of soft tissue infections and 3 cases of blood-borne infections.The clinical diagnosis accords with sepsis 3.0.They were divided into 3 groups based on whether to use LMWH and the dose of LMWH.All treatment regimens were in line with Surviving Sepsis Campaign:International guidelines for management of sepsis and septic shock : 2016.The observation group 1 with LMWH 6000 IU injected subcutaneously once a day for 7days,selected 44 cases.The observation group 2 with LMWH 6000 IU injected subcutaneously once 12 hours for 7 days,selected 13 cases,and 59 patients in the control group.To compare the coagulation function and inflammatory index before and the 3 days,the 7 days during treatment.Observe the severe haemorrhagic adverse events(cerebral hemorrhage,gastrointestinal hemorrhage,large area subcutaneous hemorrhage,respiratory bleeding,etc.).Compare the scores of APACHE Ⅱ,SOFA and the 28-day mortalities.Results:1.The general data weren’t different and had no statistical significance(p>0.05).2.Comparison with coagulation function:There was no statistical difference in PT,APTT,Fib,D-Dimer,and PLT between the three groups without treatment(p>0.05).After treatment,the levels of PT and APTT have no statistical defference(p>0.05);the levels of Fi and PLT were all increased than before treatment,the difference was statistically significant(p<0.05),the level of Fi and PLT in the observation groups were higher than the control group,the difference was statistically significant(p<0.05),the observation groups have no statistical defference(p>0.05);the levels of D-Diner were decreased than before treatment,the difference was statistically significant(p<0.05),the level of D-Diner in the observation groups were lower than the control group,the difference was statistically significant(p<0.05),the observation groups have no statistical defference(p>0.05);during the treatment,all three groups had adverse bleeding reaction,and treatment group 2 was slightly higher than the other groups,but the difference was not statistically significant(p>0.05).3.Comparison with inflammatory indexes: three groups with inflammatory indexes before treatment,including WBC,NEUT%,PCT and CRP,have no statistical defference(p>0.05).After treatment,the levels of WBC were decreased than before treatment,the difference was statistically significant(p<0.05),the three groups have no statistical defference(p>0.05);the levels of NEUT% of the three groups were decreased than before treatment,the difference was statistically significant(p<0.05),the level of NEUT% in the two observation groups were both lower than the control group,the difference was statistically significant(p<0.05),the two observation groups have no statistical defference(p>0.05);the levels of PCT and CRP were decreased than before treatment,the difference was statistically significant(p<0.05),the level in the two observation groups were both lower than the control group,the difference was statistically significant(p<0.05),the two observation groups have no statistical defference(p>0.05).4.Comparison with APACHE II and SOFA: three groups with APACHE II and SOFA before treatment have no statistical defference(p>0.05).After treatment,the scores of APACHE II and SOFA were decreased than before treatment,the difference was statistically significant(p<0.05),the scores in the two observation groups were lower than the control group,the difference was statistically significant(p<0.05),the two observation groups have no statistical defference(p>0.05).5.Comparison with 28-day mortalities: two treatment groups were slightly lower than the control group,but no statistically significant differences(p>0.05).Condusion:1.LMWH can improve the blood coagulation function,inflammatory state and prognosis of patients with sepsis,but the effect of mortality is still to be studied.2.LMWH is safer to choose 1 times/day,1 times/12 hours without significant benefit,but may increase the risk of bleeding.