不同剂量低分子肝素雾化吸人对急性肺损伤／急性呼吸窘迫综合征的作用

目的探讨不同剂量低分子肝素（LMWH）雾化吸入对急性肺损伤／急性呼吸窘迫综合征ALI／ARDS的治疗作用。方法将急诊ICU收治的（ALI／ARDS）患者64例随机分为对照组、LMWH低剂量雾化治疗组和LMWH高剂量雾化治疗组，分别测定并比较各组治疗前后的氧合指数、急性生理学和长期健康评定（APACHE）Ⅱ评分、7d病死率和凝血功能。结果低剂量和高剂量LMWH雾化吸入治疗后，ALI／ARDS患者的氧合指数提高（P〈0．05），APACHEⅡ评分及7d病死率降低（P〈0．05），凝血酶原时间（PT）以及活化部分凝血酶原时间（APTT）无显著变化（P〉0．05），高、低剂量组间无显著差异，而对照组上述指标均未见明显改变。低、高剂量LMWH雾化吸收治疗组7d病死率均为13．6％，显著低于对照组25％（χ2=0．877，P=0．349）。结论高、低剂量的LMWH雾化吸人治疗均可以改善氧合，缓解ALI／ARDS患者的症状，降低病死率，而且不会引起明显出血倾向，是ALI／ARDS的一种有前景的治疗手段。

Effects of low molecular weight heparin nebulization at different dose on acute lung injury/ acuterespiratory distress syndrome

Objective To explore the therapeutic effects of low molecular weight heparin （LMWH） nebulization at different dose on acute lung injury/acute respiratory distress syndrome （ALI/ARDS）. Methods A total of 64 ALI/ARDS patients were randomly divided into three groups：control group, LMWH nebulization at low dose group and LMWH nebulization at high dose group. PaO2/FiO2, acute physiology and chronic health evaluation（APACHEⅡ ） scores, 7 day mortality and blood coagulation of patients were evaluated and compared in three groups respectively. Results After treatment of LMWH nebulization at low or high dose, PaO2/FiO2 was significantly increased （P 〈 0.05 ）, APACHEⅡ scores and 7 day mortality were significantly decreased （P 〈0.05）, while there were no significant changes （P 〉 0.05 ） in prothrombin time （PT） and activated partial thromboplastin time （APTT）. No significant difference between treatment of LMWH nebulization at low and high dose. However, there were no significant changes in the above parameters in control group （P 〉 0.05 ）. 7 day mortality was 13.6% in low dose group and high dose group with LMWH nebulization. It significantly lower than those of the control group. Conclusions Both low and high dose of LMWH nebulization may improve oxygenation, attenuate ALI/ARDS and reduce the mortality of the patients without apparent adverse effects. This study can supply a promising method for the treatment of ALI/ARDS.