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目的探讨持续小剂量肝素对急性呼吸窘迫综合征(ARDS)的治疗作用。方法39例ARDS患者随机分为肝素组(20例)和对照组(19例)。对照组给予机械通气、抗感染、营养支持治疗;肝素组加用持续静脉注射小剂量肝素5～10U.kg-1.h-1,治疗7d。比较两组住ICU时间、机械通气时间、28-d病死率,以及治疗前后急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、C-反应蛋白(CRP)、呼吸频率(RR)、氧分压(PaO2)、氧合指数(PaO2/FiO2)、凝血功能及血小板计数(Plt)变化。结果肝素组住ICU时间、28-d病死率略低于对照组。肝素组机械通气时间、APACHEⅡ评分、CRP水平及RR明显低于对照组(P<0.05),PaO2、PaO2/FiO2、纤维蛋白原(Fib)高于对照组(P<0.05)。两组凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、Plt治疗前后均无显著差异。结论持续小剂量肝素治疗ARDS有利于改善氧合指数,缩短机械通气时间,安全有效。
Objective To investigate the therapeutic effect of continuous low dose heparin on acute respiratory distress syndrome (ARDS). Methods Thirty-nine patients with ARDS were randomly divided into heparin group (n = 20) and control group (n = 19). The control group was given mechanical ventilation, anti-infective and nutritional supportive treatment. The heparin group was treated with continuous intravenous injection of low dose heparin 5 ~ 10U.kg-1.h-1 for 7 days. The ICU time, the duration of mechanical ventilation, the 28-day mortality, the APACHEⅡ score, C-reactive protein (CRP), respiratory rate PaO2), oxygenation index (PaO2 / FiO2), coagulation function and platelet count (Plt). Results ICU time in heparin group, 28-d mortality was slightly lower than the control group. The mechanical ventilation time, APACHEⅡscore, CRP level and RR in heparin group were significantly lower than those in control group (P <0.05). PaO2, PaO2 / FiO2 and fibrinogen (Fib) were higher in heparin group than those in control group (P <0.05). Prothrombin time (PT), activated partial prothrombin time (APTT), Plt no significant difference before and after treatment. Conclusion Continuous low-dose heparin treatment of ARDS is conducive to improving oxygenation index, shorten the time of mechanical ventilation, safe and effective.