低分子肝素治疗对ICU脓毒症患者急性肺损伤／急性呼吸窘迫综合征的影响

The effects of actue lung injury/acute respiratory distress syndrome with sepsis in ICU treated with low molecular weight heparin

目的探讨低分子肝素治疗对重症监护病房（ICU）脓毒症患者急性肺损伤／急性呼吸窘迫综合征（ALI／ARDS）的影响。方法选择2011-01～2012—12上海市闵行区中心医院ICU收治的83例ALUARDS脓毒症患者，对照组采用抗感染、呼吸支持等综合治疗，肝素组在对照组基础上使用低分子肝素钠5000IU治疗（每12h1次，连续7d）。观察两组患者治疗后氧合指数、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、PLT、PT、APTT、FIB，比较两组机械通气时间、ICU人住时间、28d病死率。结果7d后肝素组氧合指数较对照组明显好转（290．7±35．4vs．239．1±51．8），APACHEII评分明显低于对照组（11．9±6．1vs．17．8±4.3）。肝素组机械通气时间（11．31±1．73vs．14．35±2．48）、ICU入住时间（16．86±2．67VS．25．60±4．15）和28d病死率较对照组下降（15．4％vs．36．4％）（P〈0．05）。PLT、PT、APTT、FIB两组治疗前后比较差异无统计学意义（P〉0．05）。结论低分子肝素治疗脓毒症患者ALI／ARDS可以提高氧合指数，减轻炎症反应，降低病死率。

Objective To discuss the effects of actue lung injury/acute respiratory distress syndrome （ALI/ARDS） with sepsis in ICU treated with low molecular weight heparin （LMWH）. Methods We recruited 83 ALI/ARDS patients with sepsis at ICU from January 2011 to December 2012, the patients in the control group were given with conventional therapy including anti-infection and mechanical ventilation therapy, and the patients in the heparin group were treated with LMWH Na on the basic of conventional therapy. Oxygenation index, acute physiology and chronic health evaluation Ⅱ, blood platelet count （PLT）, prothrombin time （PT）, activated partial thromboplastin time （APTF）, fibrinogen level （FIB） between heparin group and control group were observed （7 days after）, the duration of mechanical venlilation, ICU stay time and 28 day mortality were compared between two groups. Results Seven days after treatment, the oxygenation index improved significantly （290.7±35.4 vs.239.1 ±51.8）, the APACHE Ⅱ in heparin group （11.9±6.1 ） was markedly decreased than that of the control group （17.8 ± 4.3 ） （P 〈 0.05）, the duration of mechanical venlilation （ 11.31 ± 1.73）, ICU stay time （16.86±2.67） and 28 day mortality （15.4%）in the heparin group decreased significantly than those in the control group [ （14.35±2.48）, （25.60±4.15）, 36.4% ] （P 〈 0.05）. There were no difference in PLT, PT, APTT, FIB be-tween two groups. Conclusion LMWH is benefit to improve the oxygenation index, reduce systemic inflammation,and the mortality of the ALI/ARDS with sepsis.