肝素肺灌洗治疗ALIARDS的临床疗效观察.doc

肝素钠肺泡灌洗治疗ALI／ARDS的临床疗效观察 王晓珊1 肖金石2 邵阳市中心医院重症医学科1区 摘要：目的 探讨肝素钠(UFH)肺灌洗治疗急性肺损伤的临床疗效及可能的作用机制。方法　选择120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、肝素肺泡灌洗组和肝素雾化组。对照组：使用常规治疗基础上行生理盐水肺灌洗；肝素肺泡灌洗组：常规治疗基础上行肝素钠盐水肺灌洗；肝素雾化组：在常规治疗基础上行气道雾化吸入肝素钠。观察和比较3组患者治疗7d后氧合指数、急性生理学与慢性健康状况Ⅱ（APACHEⅡ）评分、肺泡灌洗液(BALF)中IL-6以及PLT、APTT变化、７d死亡率。结果　各组治疗7d后各项指标较前有好转，肝素肺泡灌洗组和肝素雾化组较对照组氧合指数（OI）明显升高（Ｐ＜0.01），BALF中的IL-6、APACHEⅡ评分下降显著。其中，肝素肺泡灌洗组氧合指数优于肝素雾化组，而IL-6、APACHEⅡ评分较雾化组低（Ｐ＜0.05）。肝素肺泡灌洗和肝素雾化治疗后PLT、APTT与对照组比较无差异。肝素肺泡灌洗组、肝素雾化组、对照组死亡率分别为7.5％，12.5％，26.8％，差异有统计学意义，肝素肺泡灌洗组和肝素雾化组死亡率低于对照组（Ｐ＜0.05）。结论　肝素肺灌洗和肝素雾化吸入治疗ALI／ARDS，能够改善氧合；抑制IL-6等炎症介质的释放，降低炎症反应，从而降低患者的死亡率。 关键词：肝素钠；肺泡灌洗；急性肺损伤／急性呼吸窘迫综合征 Aclinical study on acute lung injury/acute respiratory distress syndrome treated with the unfractioned heparin bronchial alveolar lavage WANG xiaoshan,XIAO jin shi Intensive medicine 1 ward Shaoyang Central Hospital,shaoyang 422800,china Abstract：Objective　To investigate the effect and possible mechanism bronchial alveolar lavage with unfractioned heparin in ALI/ARDS patients methods A total of 120 ALI/ARDS patients were randomly divided into control group, BAL group, atomizationg group．Patients in the control group were treated with routine therapy．Patients in BAL group and atomization group respectively received unfractioned heparin bronchial alveolar lavage and ultrasionic atomizing inhalation of Unfractioned heparin based on routine therapy.we observed and compared the three groups with 7d oxygen index,APACHEⅡ scores,IL-6 level of BALF and PLT,APTT change,and 7d mortality．Result The 7d indexes of three group three groups were better than before，anticoagulation group（BAL group and atomization group）were better than control group.The oxygen of BAL group was better than that of atomization group.while BALF IL-6 level and APACHEⅡscores of BAL group were lower than those of atomization group.PLT and APTT of the three groups had no significant difference during pre and pro treatments.the mortality rates of BAL group, a