低分子肝素雾化吸入治疗ALI/ARDS的临床疗效观察  

A clinical study on acute lung injury /acute respiratory distress syndrome treated with ultrasonic atomizing inhalation of low molecular weight heparin

作　　者：査佳安[1] 方长太[1] 梅玲[1] 庞礴[1] 

机构地区：[1]安徽医科大学附属安庆医院急诊科,安徽安庆246003

出　　处：《安徽医药》2012年第9期1335-1337,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨雾化吸入低分子肝素治疗急性肺损伤的临床疗效及可能的作用机制。方法选择42例急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的患者,随机分为对照组、皮下组和雾化组,对照组使用常规治疗,皮下组和雾化组则分别在常规治疗基础上采用皮下注射及气道雾化吸入低分子肝素钠。观察和比较三组患者治疗7 d后氧合指数、急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分I、L-6以及PLT、APTT变化、7 d死亡率。结果各组治疗7 d后各项指标较前有好转,抗凝组(皮下组和雾化组)较对照组氧合指数明显升高I,L-6、APACHEⅡ评分下降更显著。其中,雾化组氧合指数优于皮下组,而IL-6、A-PACHEⅡ评分较皮下组高(P<0.05)。抗凝组治疗后PLT、APTT与对照组比较无差异。皮下组、雾化组、对照组死亡率分别为6.7%,11.1%4,4.4%,组间比较有差异,抗凝组优于对照组。结论雾化吸入低分子肝素治疗ALI/ARDS,能够改善氧合;可能通过抑制IL-6等炎症介质的释放,降低全身炎症反应,从而降低患者的死亡率。Objective To investigate the effects and possible mechanism of ultrasonic atomizing inhalation of low molecular weight heparin （LMWH） in ALI/ARDS patients. Methods A total of 42 ALL/ARDS patients were randomly divided into control group, subcutaneous group and atomization group. Patients in the control group were treated with routine therapy. Patients in the subcutaneous group and atomization group respectively received subcutaneous injection and ultrasonic atomizing inhalation of LMWH Na based on routine therapy. We observed and compared the three groups with 7 d oxygen index, APACHE II scores, IL-6 and PLT, APTY change, and 7d mortality. Results The 7 d indexes of three groups were better than before, anticoagulation group （ subcutaneous group and atomization group） were better than control group. The oxygen index of atomization group was better than that of subcutaneous group, while IL-6 and A- PACHE II scores of atomization group were higher than those of subcutaneous group. PLT and APTT of the three groups had no significant difference during pre-and-pro treatments. The mortality rates of subcutaneous group, atomization group, control group were 6.7% , 11.1% ,and 44.4% ,respectively. There was difference between the three groups. Anticoagulation group was better than control group. Conclusion Ultrasonic atomizing inhalation of LMWH could activate fibrinolysis system and improve ventilate function, inhibit the release of IL-6, reduce systemic inflammation, which can eventually reduce the mortality of the patients.

关 键 词：肝素 急性肺损伤/急性呼吸窘迫综合征 雾化吸入 

分 类 号：R512.91[医药卫生—内科学]