低分子肝素治疗急性呼吸窘迫综合征的疗效

Efficacy of low molecular weight heparin in treating acute respiratory distress syndrome

目的观察低分子肝素(LMWH)治疗急性呼吸窘迫综合征(ARDS)的临床效果。方法ARDS患者62例随机分为两组:C组30例,予以原发病治疗、机械通气和广谱抗生素等常规治疗;L组32例,加用LMWH 4100U皮下注射,每天1次,连续7d。比较两组患者治疗前后血气分析、凝血指标和血管外肺水指数(EVLWI)变化,行急性生理与慢性健康评分(APACHEⅡ),统计ICU住院时间和28-d病死率。结果治疗后,L组氧合指数、EVLWI和APACHEⅡ评分的改善均优于C组(P<0.05);两组患者治疗前后血小板、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(Fib)均无统计学差异(P>0.05);仅L组治疗第7天的PT长于C组(P<0.05)。L组住ICU时间短于C组(P<0.05);L组28-d病死率稍低于C组(P>0.05)。Logistic回归分析显示,EVLWI和APACHEⅡ评分是ARDS患者死亡的独立影响因素。结论在常规治疗基础上加用LMWH可增强对ARDS的疗效。

Objective To observe the efficacy of low molecular weight heparin（LMWH）in treating acute respiratory distress syndrome（ARDS）.Methods Sixty-two patients with ARDS were randomly treated with conventional treatments of primary disease,mechanical ventilation and broadspectrum antibiotics（group C,30 cases）or with additional LMWH 4100 Uinjection subcutaneously daily for 7 days（group L,32 cases）.The changes of oxygenation index（OI）,extravascular lung water index（EVLWI）,coagulation indicators and APACHE Ⅱ score were observed before and during treatment.The ICU stay and 28-day mortality were compared between two groups.Results The improvements of OI,EVLWI and APACHE Ⅱ after treatment were better in group L than those in group C（P〈0.05）.There were no significant differences in Plt count,PT,APTT and Fib before and after treatment between two groups（P〉0.05）.PT on the 7^th day of treatment was longer in group L than that in group C（P〈0.05）.The ICU stay was shorter in group L than that in group C（P〈0.05）.The 28-day mortality of group L was slightly lower than that of group C（P〈0.05）.Logistic regression analysis showed that EVLWI and APACHEⅡ were the independent impact factors for death of ARDS cases.Conclusion On the basis of conventional treatments for ARDS,additional use of LMWH can enhance the efficacy.