应用小剂量肝素治疗急性呼吸窘迫综合症的临床疗效

目的探讨应用小剂量肝素治疗急性呼吸窘迫综合症(ARDS)患者的临床疗效。方法将我院重症医学科(ICU)住院治疗的明确诊断为ARDS的患者66人,随机分为试验组(34例)和对照组(32例),对照组给予常规治疗,试验组在常规治疗的基础上加用小剂量肝素(5～10 U/kg/h)持续泵入,测定两组间患者治疗前、治疗后第1天、第3天、第5天、第7天氧合指数(PaO2/FiO2)、呼吸频率(R)、血小板计数(PLT)、部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、组织因子途径抑制物(TF-PI)。观察两组患者平均机械通气时间、平均ICU住院时间及28天病死率。结果与对照组相比,治疗后3、5、7天实验组PaO2/FiO2明显升高,R、TFPI含量明显下降,PLT、APTT、FIB含量无明显变化;对照组平均机械通气时间、ICU住院时间均显著低于对照组,28 d病死率较对照组有所降低。结论小剂量肝素治疗急性呼吸窘迫综合征疗效显著,临床应用安全。

Observation of curative effect of low-dose heparin in the treatment of patients with acute respiratory distress syndrome

Objective To explore the curative effect of low-dose heparin in the treatment of patients with acute respiratory distress syndrome（ARDS）.Methods 66 patients confirmed with ARDS in ICU were all given the conventional treatment and then were randomly divided to the control group（n=32） and the experiment group（n=34）.The experiment group was continuously pumped with low-dose heparin（5~10 U/kg/h）.Oxygenation index（PaCO2/FiO2）,respiratory rate（R）,PLT,APTT,Fibrinogen（FIB）,and tissue factor pathway inhibitor（TFPI） were tested before and the 1st,3rd,5th and 7th days after the treatment.The duration of mechanical ventilation and hospital stay in ICU and mortality during 28 days were observed.Results Compared with the control group,the level of PaO2/FiO2 increased obviously,and the level of TFPI and the respiratory rate decreased significantly at the 3rd,5th,and 7th days after the treatment in the experiment group（P0.05）.There was no significant difference of the levels of PLT,APTT,and FIB between the two groups.The mortality during 28 days and the duration of hospital stay in ICU decreased more obviously in the experiment group than in the control group after the treatment.Conclusion Low-dose heparin can improve the prognosis of ARDS with a high safety of clinical application.