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（AL姒RDS）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人肝素钠。观察和比较3组患者治疗7d后氧合指数、急性生理学号陧性健康状况Ⅱ（APACHEI／）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、APT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。
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, and atomizationg group. Patients in the control group were treated with routine therapy, while patients in BAL group and atomization group respectively received unfractionated heparin bronchial alveolar lavage and ultrasonic atomizing inhalation of unfractionated heparin on top of the routine therapy. The three groups with 7 days of oxygen index, APACHE Ⅱ scores, IL-6 level of BALF, and PLT, APTT change, and 7 days mortality were observed and compared. Results The 7-day indexes reflected a better result in all three groups, and anticoagulation group （BAL group and atomization group） was better than control group. The oxygen of BAL group was better than that of atomization group, while BALF IL-6 level and APACHE Ⅱ scores of BAL group were lower than those of atomization group. PLT and APTT of the three groups had no significant difference before and after the treatments was offered. Mortality rates of BAL group, atomizationg group, and control group were 7.5%, 12.5%, and 26.8%, respectively. Difference was found among the three groups. Antieoagulation group was better than control group. Conclusion It was proved that UFH bronchial alveolar lavage resulted in activating fibrinolysis system and improving ventilate function, lowering local eoagulability, and inhibiting the release of IL-6, reducing the systemic inflammation, which is considered being effective eventually reducing mortality of the patients.
出处
《中国急救复苏与灾害医学杂志》
2014年第1期49-52,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
