A Randomized Controlled Clinical Trial Of Heparin In The Treatment Of Septic DIC

Objective:To study the efficacy and safety of heparin in the treatment of sepsis DIC.Methods:Observational randomized controlled study,42 adult patients who were admitted to the intensive care department of the Second Affiliated Hospital of Kunming Medical University on September 1,2017 to February 28,2019 and were diagnosed with sepsis or septic shock and met the criteria of simplified JSTH diagnostic DIC were selected.The patients were randomly and blinding divided into experimental group(heparin group)and control group(normal saline group).Before the experiment,patients in both groups were given the 2016SSC guidelines for the recommendation of sepsis cluster therapy,and then the experimental group(heparin group)was given heparin 100U/kg within two hours after the diagnosis of sepsis DIC,with a total configuration of 50ml.Uniform pumping at 24 hours,the control group(normal saline group)was given the same dose of normal saline at 24 hours uniform pumping.General information:gender,age,height,weight and basic diseases(hypertension,diabetes).Clinical data collection:The coagulation function indexes(including PT?INR?APTT?Fib?DD?FDPs?AT activity and PLT)of the patients after admission were recorded.The APACHE ? score and SOFA score of Oh for the two groups of patients diagnosed with sepsis DIC was recorded.Meanwhile,the changes of coagulation indexes(including PT,INR,APTT,Fib,DD,FDPs and PLT)of the patients were recorded repeatedly at Oh,24h,72h,120h and 168h.Records of patients in the ICU hospitalization days,breathing machine mechanical auxiliary ventilation treatment time,vascular active drug use time,mortality and 28 days after treatment(168 h)of APACHE ? score,SOFA score,during the whole experiment closely observed whether patients with intracranial hemorrhage,hematemcsis.black.airway mucosa bleeding gums,nose bleeding,bleeding,gastrointestinal bleeding,the puncture point ooze blood,skin purpura,large ecchymosis,allergic reactions and adverse reactions such as HIT.Statistical test was performed on the obtained data,and P<0.05 was considered statistically significant.Results1.There were no statistically significant differences between the two groups in age,gender,height,weight,initial APACHE II score,SOFA score and coagulation indexes PT?INR?APTT?Fib?DD?FDPs?AT activity and PLT at admission,with P values greater than 0.05.2.The changes of PT?INR?APTT?Fib?DD?FDPs?AT activity and PLT in the two groups at each time point were compared,and it was found that there was an interaction between Fib and PLT and time in the two groups(Fib:P value<0.001,PLT:P value<0.001).After general effect analysis,it was found that the rising trend of Fib and PLT in the heparin group at 120h and 168h was greater than that in the control group.However,compared with the treatment methods of the two groups,there were no statistically significant differences in the coagulation indexes of PT?INR?APTT?Fib?DD?FDPs?AT activity and PLT after treatment,and the P values were all greater than 0.05.The difference in AT activity between the two groups was statistically significant(P=0.027),suggesting that heparin treatment could increase AT activity in patients with sepsis DIC.3.The length of stay in the ICU,the duration of mechanical ventilation and the 28-day mortality of the two groups were all<0.05,with statistically significant differences,indicating that heparin treatment for patients with sepsis DIC could shorten the length of stay in the ICU(P=0.024),reduce the duration of mechanical ventilation(P=0.029)and reduce the mortality(P=0.047).4.APACHE ? scores of patients in the two groups were significantly lower after treatment than before treatment,but the difference between the two groups was not statistically significant(P=0.113).After treatment,the SOFA score in the heparin group was significantly lower than that before treatment(P<0.001).After treatment.the difference between the control group and before treatment was not statistically significant(P=0.271).The difference between the two groups was statistically significant(P=0.028).5.This experiment both given heparin group and control group in patients with no intracranial hemorrhage occurred,hematemesis,black,airway mucosa bleeding gums,nose bleeding,bleeding,gastrointestinal bleeding,the puncture point ooze blood,skin purpura,large ecchymosis,adverse reactions such as allergic reactions and HIT,prompt heparin for the treatment of sepsis patients with DIC has certain security,did not increase the risk of bleeding.Conclusion1.Heparin treatment of DIC in patients with sepsis did not cause coagulation dysfunction,and there was no statistically significant difference in the changes of coagulation indexes PT?INR?APTT?Fib?DD?FDPs and PLT.However,heparin treatment can increase AT activity in patients with DIC in sepsis2.Heparin treatment for patients with DIC can reduce the length of stay in ICU,SOFA score,duration of mechanical ventilation and 28-day mortality.3.Treatment with low-dose heparin in patients with sepsis DIC does not increase the risk of bleeding.